A federal appeals court has handed down a landmark decision requiring state health insurance plans in North Carolina and West Virginia to cover gender-affirming care. This ruling, issued by the 4th Circuit Court of Appeals in Richmond, Virginia, marks a significant victory for transgender advocates amidst a backdrop of increasing legislative challenges to transgender rights.
The court’s decision, delivered in an 8-6 vote, stems from two cases. One involved transgender North Carolina state employees and their dependents who were denied coverage for gender-affirming care. The second case concerned West Virginians on Medicaid who faced limitations on coverage, particularly for surgical procedures despite being eligible for hormone treatments.
Judge Roger Gregory, in the majority opinion, condemned the denial of coverage as “obviously discriminatory.” This ruling overturns previous policies that excluded certain transgender health care services from coverage, bringing relief to affected individuals and setting a precedent for other states.
However, reactions to the decision have been mixed. West Virginia Attorney General Patrick Morrisey has vowed to challenge the ruling at the Supreme Court, criticizing the appellate court’s composition and labeling the decision as politically motivated. Similarly, North Carolina State Treasurer Dale Folwell denounced the ruling as “unabashed judicial activism.”
Lambda Legal’s senior counsel, Tara Borelli, who represented the plaintiffs, expressed satisfaction with the outcome, emphasizing that discriminatory practices have no place in health care access. Borelli highlighted that these policies have already been revised following lower federal court rulings in 2022, which found in favor of the plaintiffs.
The implications of this decision extend beyond North Carolina and West Virginia. Borelli asserts that the ruling sets a precedent that demands attention from other states across the country.
This court decision coincides with broader legal and political developments concerning transgender rights. While the Supreme Court recently allowed Idaho’s ban on gender-affirming care for minors to proceed, it has declined to take up other cases related to transgender students’ access to facilities and sports participation. Observers interpret these actions as a cautious approach by the Supreme Court to navigate contentious transgender issues.
In a separate development, the Biden administration issued regulations strengthening protections against discrimination for transgender patients nationwide, underscoring broader efforts to safeguard transgender individuals’ rights in healthcare settings. However, these initiatives face opposition from Republican-led states, with challenges expected in the courts.
