Federal Court Rules State Health Plans Must Pay for Trans Care

A federal appeals court in Virginia ruled Monday that state healthcare plans must pay for transgender care.

The ruling stemmed from battles over West Virginia and North Carolina's refusal to cover certain healthcare for transgender people with government-sponsored insurance.

The Richmond-based 4th U.S. Circuit Court of Appeals ruled 8-6 that the states' plans are discriminatory.

West Virginia Attorney General Patrick Morrisey immediately released a statement announcing his office's intention to appeal.

“Decisions like this one, from a court dominated by Obama- and Biden-appointees, cannot stand: we’ll take this up to the Supreme Court and win,” Morrisey said.

After 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 “deeply dehumanizing.”

"I am so relieved that this court ruling puts us one step closer to the day when Medicaid can no longer deny transgender West Virginians access to the essential healthcare that our doctors say is necessary for us,” Anderson said in a statement.

During oral arguments in September, at least two judges said it’s likely the case will eventually reach the U.S. Supreme Court.

Both states appealed separate lower court rulings that found the denial of gender care to be discriminatory and unconstitutional. Two panels of three Fourth Circuit judges heard arguments in both cases last year before deciding to intertwine the two cases and see them presented before the full court of 15.

In June 2022, a North Carolina trial court demanded the state plan pay for “medically necessary services,” including hormone therapy and some surgeries, for transgender employees and their children. The judge had ruled in favor of the employees and their dependents, who said in a 2019 lawsuit that they were denied coverage for gender -related healthcare under the plan.

The North Carolina state insurance plan provides medical coverage for more than 750,000 teachers, state employees, retirees, lawmakers and their dependents. While it provides counseling for gender dysphoria and other diagnosed mental health conditions, it does not cover treatment “in connection with sex changes or modifications and related care.”

In August 2022, a federal judge ruled West Virginia’s Medicaid program must provide coverage for such care for transgender residents.

An original lawsuit filed in 2020 also named state employee health plans. A settlement with The Health Plan of West Virginia Inc. in 2022 led to the removal of the exclusion on gender-related healthcare in that company’s Public Employees Insurance Agency plans.

Newsmax staff and The Associated Press contributed to this report.