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Judges rule that West Virginia and North Carolina transgender care coverage policies are discriminatory

The 4th U.S. Circuit Court of Appeals ruled that West Virginia and North Carolina’s exclusion of government-sponsored health care coverage for transgender individuals is discriminatory. The majority opinion stated that the exclusions are based on sex and gender identity, rather than an important government interest. The decision is likely to be appealed to the U.S. Supreme Court, as it is the first U.S. Court of Appeals ruling on government-sponsored coverage exclusions for gender-affirming medical care. The ruling is part of a larger legal battle over transgender rights in various courts across the country. West Virginia’s Attorney General plans to appeal the decision, citing financial challenges faced by the state’s health plan. In response, North Carolina State Treasurer expressed hope that the U.S. Supreme Court will correct the decision, claiming it is in conflict with other federal appeals court rulings. The majority opinion highlighted that the cost of treatment is not a valid argument to support discriminatory policies. The case dates back to 2020, involving separate lower court rulings that found the denial of gender-affirming care to be unconstitutional in both states. In past cases, federal judges have ruled in favor of providing coverage for medically necessary gender-affirming care to transgender individuals. The states’ lawyers argued that gender dysphoria treatments are excluded for everyone, regardless of gender identity, as only a subset of transgender individuals are diagnosed with gender dysphoria. However, the majority opinion rejected this argument by stating that gender dysphoria is closely related to transgender status and that exclusion of treatments for gender dysphoria is essentially discriminating against transgender identity. The ruling was welcomed by West Virginia plaintiff Shauntae Anderson, a Black transgender woman, who called the state’s refusal to cover her care as “deeply dehumanizing.”


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