(CHARLESTON, W.Va.) — West Virginia and North Carolina’s refusal to cover certain health care for transgender people with government-sponsored insurance is discriminatory, a federal appeals court ruled Monday in a case that it will likely be taken to the U.S. Supreme Court.
The Richmond-based 4th U.S. Circuit Court of Appeals ruled 8-6 in the case involving North Carolina state employee health plan coverage of gender-affirming care and coverage of affirming surgery gender analysis through West Virginia Medicaid.
“Coverage exclusions discriminate facially on the basis of sex and gender identity and are not substantially related to an important government interest,” said Judge Roger Gregory, first appointed by former President Bill Clinton and reappointed by former President George W. Bush. wrote in the majority opinion.
The ruling follows a ruling earlier this month by 4th Circuit judges that West Virginia’s ban on transgender sports violates a teen athlete’s rights under Title IX, the federal civil rights law which prohibits discrimination based on sex in schools.
As with the transgender sports law ruling, West Virginia Attorney General Patrick Morrisey said his office plans to appeal Monday’s health case ruling.
“Decisions like this, from a court dominated by Obama and Biden appointees, cannot stand: we will take this to the Supreme Court and we will win,” Morrisey said in a statement.
Following the ruling, West Virginia plaintiff Shauntae Anderson, a Black transgender woman and West Virginia Medicaid participant, called her state’s refusal to cover her care “profoundly dehumanizing.”
“I am so relieved that this court ruling brings us one step closer to the day when Medicaid can no longer deny transgender West Virginians access to the essential health care our doctors say we need,” Anderson said in a communicated.
A spokesman for North Carolina State Treasurer Dale Folwell, whose department oversees the state’s health plan, said the agency was still reviewing the decision Monday but would have a response later.
During oral arguments in September, at least two justices said it was likely the case would eventually reach the U.S. Supreme Court. Both states appealed separate lower court rulings that found the denial of gender-affirming care discriminatory and unconstitutional. Two three-judge panels from the Fourth Circuit heard arguments in both cases last year before deciding to intertwine the two cases and see them presented to the full court.
In June 2022, a North Carolina Trial Court required the state plan to pay for “medically necessary services,” including hormone therapy and some surgeries, for transgender employees and their children. The judge ruled in favor of the employees and their dependents, who claimed in a 2019 lawsuit that they were denied coverage for gender-affirming care under the plan.
North Carolina’s state insurance plan provides medical coverage for more than 750,000 teachers, state employees, retirees, legislators and their dependents. While it provides counseling for gender dysphoria and other diagnosed mental health conditions, it does not cover treatment “related to sex changes or modifications and related care.”
In August 2022, a federal judge ruled that West Virginia’s Medicaid program must provide coverage for gender-affirming care for transgender residents.
One original process filed in 2020 also named health plans for state employees. A settlement with West Virginia Health Plan Inc. in 2022 led to the removal of the gender-affirming care exclusion in that company’s Public Employees Insurance Agency plans.
During September oral arguments, lawyers for the state of North Carolina said the state-sponsored plan is not required to cover hormone therapy or gender-affirming surgery because being transgender is not an illness. They claimed that only a subset of transgender people suffer from gender dysphoria, a diagnosis of distress about gender identity that does not correspond to a person’s assigned sex.
Before offering pharmaceutical or surgical intervention, medical guidelines require full psychological evaluations to confirm gender dysphoria before starting any treatment.
Lawyers for West Virginia said the U.S. Centers for Medicare and Medicaid Services has refused to issue a national coverage ruling on gender-affirming surgeries.
State lawyers said West Virginia’s policy is also not a case of discrimination, but of a state trying to make the best use of limited resources. West Virginia has a $128 million Medicaid shortfall for next year, expected to expand to $256 million in 2025.
Unlike North Carolina, the state has covered hormone therapy and other pharmaceutical treatments for transgender people since 2017.
This story originally appeared on Time.com read the full story
