CHARLESTON, W.Va. – West Virginia is seeking a review from the U.S. Supreme Court regarding recent rulings that deemed the state’s denial of certain health care services for transgender individuals discriminatory. This appeal follows an April decision by the 4th U.S. Circuit Court of Appeals, which ruled 8-6 that West Virginia Medicaid’s exclusion of gender-affirming surgeries was discriminatory. Judge Roger Gregory, writing for the majority, stated that these exclusions “facially discriminate based on sex and gender identity.”
Republican Attorney General Patrick Morrisey expressed concerns about the state’s financial constraints during a live-streamed briefing on Thursday. Morrisey argued that West Virginia, known for its limited resources and high poverty rates, cannot afford to cover all medical treatments. “We’re not a rich state — we can’t afford to do everything,” he said. He explained that allocating funds for gender-affirming surgeries could divert resources from other essential treatments for conditions such as heart disease and diabetes.
The 4th Circuit’s majority opinion rejected the argument that financial limitations justify discriminatory practices, emphasizing that budget constraints do not provide a valid reason for upholding discriminatory policies. “Especially where government budgets are involved, there will frequently be a ‘rational’ basis for discrimination,” wrote Judge Gregory.
Morrisey did not provide specific data on the number of Medicaid recipients in West Virginia seeking gender-affirming surgeries or the associated costs, stating that such details are not central to the case.
Andrew Schneider, executive director of the LGBTQ+ advocacy group Fairness West Virginia, criticized the appeal, asserting that the state has a moral obligation to support marginalized groups. Schneider noted that other states with similar coverage policies have not experienced significant cost increases and placed blame on underfunding by the Republican-controlled Legislature rather than on the transgender community.
The case also involves North Carolina, which has a similar exclusionary policy in its state employee health plan. North Carolina is also requesting the U.S. Supreme Court to review its case.
These cases mark a significant development in the legal landscape concerning government-sponsored coverage of gender-affirming medical care. The April decision was the first by a U.S. Court of Appeals to address the legality of such coverage exclusions.
In August 2022, a federal judge had already ruled that West Virginia’s Medicaid program must include coverage for gender-affirming care for transgender residents. This ruling followed a 2020 lawsuit that also challenged state employee health plans. A subsequent settlement with The Health Plan of West Virginia Inc. led to the removal of gender-affirming care exclusions from that company’s Public Employees Insurance Agency plans. Since 2017, West Virginia has covered hormone therapy and some pharmaceutical treatments for transgender individuals, though exclusions remain for certain surgeries not related to gender dysphoria, such as those needed for cancer treatment.
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