Court Rules State Exclusion of ‘Gender-Affirming’ Treatments Violates Consitution

U.S. Court of Appeals for the Fourth Circuit ruled against West Virginia and North Carolina, saying the states must pay for transgender healthcare.

In an 8-6 decision, the court declared that excluding transgender surgeries from North Carolina’s state-employee health plan and West Virginia’s Medicaid violates the U.S. Consitution.

Judge Roger Gregory wrote in the majority opinion that excluding “gender-affirming” treatments violates the 14th Amendment’s Equal Protection Clause.

“The North Carolina and West Virginia Appellants’ central argument is that the coverage exclusions do not discriminate against a suspect or quasi-suspect class and are rationally related to legitimate government interests,” he wrote. “Because we hold that the coverage exclusions facially discriminate on the basis of sex and gender identity, and are not substantially related to an important government interest, we affirm the district courts. We further hold that the West Virginia exclusion violates the Medicaid Act and the Affordable Care Act.”

“[G]ender dysphoria is so intimately related to transgender status as to be virtually indistinguishable from it,” he added. “The excluded treatments aim at addressing incongruity between sex assigned at birth and gender identity, the very heart of transgender status.”

Lambda Legal, which challenged the states’ policies, declared that it was “pleased” with the decision.

“We are pleased with the Court’s decision, which will save lives,” said Tara Borelli, Lambda Legal’s Senior Counsel. “It confirms that discriminating against transgender people by denying critical medical care is not only wrong but unconstitutional. No one should be denied essential health care, but our clients in both cases were denied coverage for medically necessary care prescribed by their doctors just because they’re transgender.”

West Virginia Attorney General Patrick Morrisey plans to take the case to the Supreme Court.

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

“We are confident in the merits of our case: that this is a flawed decision and states have wide discretion to determine what procedures their programs can cover based on cost and other concerns. Just one single sex-transition surgery can cost tens of thousands of dollars—taxpayers should not be required to pay for these surgeries under Medicaid. Our state should have the ability to determine how to spend our resources to care for the vital medical needs of our citizens.”