RICHMOND, Virginia – A federal appeals court has heard oral arguments for a case in which West Virginia seeks to reverse a lower court ruling requiring the state’s Medicaid program to treat transgender people’s healthcare needs.
The U.S. Court of Appeals for the Fourth Circuit heard the arguments March7 in the class-action case filed in 2020 against the state Department of Health and Human Resources Bureau for Medical Services, former DHHR Secretary William Crouch and BMS Commissioner Cynthia Beane.
The case was filed in 2020 challenging the state’s exclusion of healthcare for transgender people in the state Medicaid program. Last year, a settlement with The Health Plan of West Virginia led to the removal of the exclusion on coverage for gender-confirming care in The Health Plan’s PEIA plan for state employees.
On August 2, U.S. District Judge Chuck Chambers ruled in favor of the Medicaid plaintiffs, saying the state’s exclusion violated the Fourteenth Amendment’s Equal Protection Clause, the Affordable Care Act and the Medicaid Act.
“Accessing Medicaid coverage for gender-confirming care is vital to the livelihood and survival of myself and other transgender community members. West Virginia’s choice to appeal with the hope to deny us life-saving medical care is both demoralizing and shameful,” said Shauntae Anderson, one of the plaintiffs in the case.
According to a Bloomberg News article about Tuesday’s arguments, the plaintiffs were “met with skepticism by Judges Julius N. Richardson and Allison Jones Rushing, who appeared to be convinced by the state’s argument that the exclusion is justified because it’s based solely on a diagnosis of gender dysphoria, not a patient’s transgender status.
“Judge Diana Gribbon Motz was more focused on the medical procedures in question, asking why Medicaid coverage is different based on whether the patient is transgender or cisgender if the procedure is the same.”
Bloomberg said the case is “emblematic of a conservative backlash that’s threatened the rights of transgender individuals and access to gender-affirming care in several states” because state policy doesn’t ban access itself but essentially does so “because many transgender people are unable to afford surgery without Medicaid.”
Some procedures such as hysterectomies and vaginoplasties are performed to treat gender dysphoria, but the state officials say West Virginia Medicaid has paid for a hysterectomy for one of the transgender male plaintiffs because the diagnosis would apply to cisgender women, attorney Caleb David noted.
“I am outraged that West Virginia is wasting time and resources to appeal a court decision simply because our state would like to be allowed to discriminate against transgender West Virginians,” plaintiff Christopher Fain said.
The lead plaintiffs’ attorney said the case is simple.
“All our plaintiffs' request is to receive equal access to medically necessary care,” Avatara Smith-Carrington of Lambda Legal said. “West Virginia’s decision to appeal the well-reasoned and legally sound ruling of the district court in order to be able to continue its discriminatory targeting of transgender West Virginia Medicaid participants is infuriating.”
Other attorneys representing the plaintiffs are Tara Borelli, Carl Charles, Sasha Buchert and Nora Huppert of Lambda Legal, Anna Prakash and Nicole Schladt of Nichols Kaster and Walt Auvil of the Employment Law Center.
The defendants are being represented by David, Kimberly M. Bandy, Lou Ann S. Cyrus and Roberta F. Green of Shuman McCuskey Slicer in Charleston.
U.S. Court of Appeals for the Fourth Circuit case number 22-1927