Federal Appeals Court Reviews Transgender Health Coverage Cases, Eyeing Potential Supreme Court Litigation

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A United States federal appeals court is presently reviewing pivotal cases originating from North Carolina and West Virginia, which could substantially impact whether states are mandated to extend health care coverage to transgender individuals via government-funded insurance plans.

The 4th U.S. Circuit Court of Appeals, based in Richmond, recently conducted oral hearings on matters pertaining to the coverage of gender-affirming care through North Carolina’s state employee health program and gender-affirming surgical procedures under West Virginia’s Medicaid system.

During the court sessions, multiple judges expressed the view that these cases will likely be escalated to the U.S. Supreme Court for final adjudication. Both states have appealed earlier court decisions that ruled against them, stating that the denial of gender-affirming medical treatments is both discriminatory and in violation of constitutional principles. Prior to this, panels comprising three judges from the Fourth Circuit had heard each of the cases separately before opting to consolidate them and present them before the full court consisting of 15 judges.

Lambda Legal’s Senior Attorney, Tara Borelli, who is representing the transgender plaintiffs who were denied medical services in both states, emphasized that the denial of coverage constitutes direct discrimination, contravening the Fourteenth Amendment. In her courtroom argument, Borelli insisted that a faithful reading of the U.S. Constitution’s equal protection clause necessitates coverage for transgender individuals.

Legal representatives for the state of North Carolina countered that the state’s insurance plan is not legally obligated to cover gender-affirming therapies or surgeries as transgenderism is not classified as a medical illness. Attorney John Knepper posited that only a particular subset of transgender individuals experience gender dysphoria, a diagnostic term for emotional distress arising from a mismatch between one’s gender identity and assigned sex at birth.

Legal counsel for West Virginia maintained that their case is not one of discrimination, but rather a matter of the state judiciously allocating its limited resources amid a growing Medicaid deficit. The state plans to prioritize funding for prevalent health issues such as heart disease, diabetes, drug addiction, and cancer.

There is yet no timeline for when the appeals court will deliver its judgment. In June 2022, a North Carolina court mandated that the state’s health plan should cover “medically necessary services,” inclusive of hormone therapy and certain surgeries, for its transgender employees and their dependents. Meanwhile, a federal judge in West Virginia decreed in August 2022 that the state’s Medicaid program must include coverage for gender-affirming care.

The legal actions come against a backdrop of broader debates on transgender rights and healthcare coverage. Outcomes of these cases could have profound implications for transgender individuals and for the evolving understanding of healthcare as a constitutional right.

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More about Transgender Health Coverage Cases

• Fourth Circuit Court of Appeals
• Lambda Legal
• 14th Amendment of the U.S. Constitution
• Transgender Healthcare Rights
• U.S. Supreme Court
• Transgender Rights and Discrimination
• Medicaid Program
• Transgender Healthcare Coverage