North Carolina and West Virginia’s Transgender Policies Are Discriminatory, Court Rules

The 4th U.S. Circuit Court of Appeals upheld rulings by two lower courts that state health care plans and government-funded insurance cannot ban coverage for gender-affirming care. This is a significant victory for transgender rights among the vast number of anti-trans legislation. 

State attorneys’ arguments 

Attorneys for North Carolina and West Virginia argued that the decisions were over cost concerns and were not made to be against transgender people. However, Judge Roger Gregory wrote in his majority opinion that the decision was discriminatory. The Judge was appointed by Clinton and re-appointed by Bush. 

The bans 

North Carolina’s policy prohibits treatment or research regarding sex changes or care related to it. West Virginia’s policy bans any coverage of so-called transsexual surgery. The Fourth Circuit released an 8-6 decision that upheld the lower courts’ decisions. West Virginia’s Medicaid removed the surgery in 2004, while North Carolina removed gender dysphoria treatment from the state’s health care plan.

West Virginia’s Medicaid deficit 

State attorneys asserted that West Virginia will have a $128 million deficit in Medicaid in 2024 and $256 million in 2025. Unlike North Carolina, the state covered hormone therapy and similar treatments until 2017. Both sides presented their cases last September. 

Next stop, the Supreme Court 

West Virginia Attorney General Patrick Morrisey announced the appeal, adding that the state will take the case to the Supreme Court. He said that the decisions of Obama and Biden appointees could not stand. 

North Carolina is also likely taking the case to SCOTUS 

In a press release, North Carolina State Treasurer Dale Folwell shared that the Court’s decision conflicts with other court rulings and SCOTUS. Folwell hopes that the Supreme Court will undo the Fourth Circuit ruling. But, according to the majority opinion, both states failed to prove their policies. 

North Carolina vs. Federal Court

The attorneys for North Carolina argued that the state-sponsored plan is not required to cover gender-affirming hormone therapy or surgery because being transgender is not an illness. A federal judge in 2022 ruled that North Carolina’s health plan discriminates against transgender people, and the Federal Court upheld the decision. 

Inside the ruling 

Judge Gregory and others asked about mastectomies, which are covered by insurance but only for cancer patients. The Federal Court found that attorneys did prove that gender-dysphoria treatments are ineffective. The North Carolina Appellants’ arguments were more substantial than those of West Virginia, as the Judge wrote in the majority opinion. 

West Virginia plaintiff feels relief 

West Virginia plaintiff Shauntae Anderson, a Black transgender woman and West Virginia Medicaid participant, called out the state’s policy as dehumanizing. However, she is relieved by the ruling. She said this is one step toward getting the health care recommended by the doctors. 

The lead lawyer in both lawsuits said this ruling was life-saving  

Tara Borelli, senior attorney at Lambda Legal and the lead lawyer in both lawsuits, called the verdict a lifesaver. She added it confirms that withholding critical medical care from transgender people is both unconstitutional and morally wrong.

Two Judges previously mentioned SCOUTS

The A.P. reported that two judges believe the case will reach the Supreme Court. West Virginia Attorney General Patrick Morrisey is confident in the conservative majority of the Court. He believes taxpayers shouldn’t fund gender reassignment surgeries and that West Virginia should decide how to distribute resources for medical needs.

Over 100 anti-trans bills in 2024 alone

the American Civil Liberties Union reported that over 100 anti-trans bills were introduced in 2024 alone. The Movement Advancement Project warned that half of the U.S. does not have inclusive insurance for LGBTQ+ community members. Mississippi and Arkansas allow insurance to deny gender-affirming care, the report added.

What to expect from SCOTUS 

SCOTUS permitted Idaho’s ban on gender-affirming care for minors but declined to hear cases concerning transgender students’ bathroom access and participation in school sports. Many pointed out that the Supreme Court’s decisions are usually mixed. 

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