West Virginia Medicaid Must Cover Transgender Care, Federal Judge Rules

West Virginia’s Medicaid program can no longer exclude coverage for “gender-affirming” surgeries, a federal judge ruled this week.

U.S. District Judge Robert C. Chambers ruled in favor of a lawsuit filed nearly two years ago by LGBT rights organization Lambda Legal on behalf of two transgender men in West Virginia who were denied “gender-affirming” care under the state’s Medicaid program and the state’s employee health plan.

“This case is about discrimination in health care and employment. Plaintiffs bring this suit to challenge discrimination under West Virginia state health insurance plans that deprive transgender people of essential, and sometimes life-saving, health care,” the complaint stated. It claimed that transgender people were discriminated against in several ways.

Defendants violate the law in two ways. First, Defendants discriminate against low-income transgender people who are Medicaid participants. Inflicting grave harm on a particularly vulnerable group of people, Defendants deny low-income transgender Medicaid participants the same health coverage others receive, targeting them for discrimination based on their sex and transgender status. This care is for the treatment of gender dysphoria—the clinically significant distress that can result from the dissonance between an individual’s gender identity and sex assigned at birth—and is also known as gender-confirming care. Defendants categorically deny gender-confirming care to transgender Medicaid participants, even though it is medically necessary and can be life-saving, while routinely providing cisgender participants the same treatments. Second, Defendants discriminate against state employees and their dependents, by denying coverage for gender-confirming care, even though cisgender people receive the same kinds of treatments as a matter of course.

It is undisputed that the criteria determining whether or not such treatment is covered under the Medicaid Program hinges on a diagnosis – but when treatment is precluded for a diagnosis based on one’s gender identity, such exclusion invidiously discriminates on the basis of sex and transgender status.

Later in the opinion, Chambers, who was nominated by President Bill Clinton, used mastectomies as an example of how excluding “gender-affirming” surgeries for transgender people violates the Medicaid Act.

Plaintiffs assert that Defendants violate the comparability requirement of the Medicaid Act by providing particular services to some Medicaid participants but not others based solely on diagnosis. The Court has found that the surgeries, such as mastectomies, which are covered to treat non-gender dysphoria diagnoses are materially the same as the surgeries provided to treat gender dysphoria. Thus, the difference in treatment clearly violates the comparability requirement which requires that all persons within a specific category be treated equally.

“The exclusion is aimed specifically at a gender change procedure,” the judge added. “The exclusion targets transgender people because they are transgender.”

Townhall reported this week how the Florida Medical Board is considering a proposal from the Department of Health to block physicians from providing “gender-affirming” treatment to children who identify as transgender. This would include puberty blockers, hormone therapy, and sex reassignment surgery. Florida’s Department of Health previously came out against “gender-affirming” care for children, including letting minors “socially” transition.

“Only a minority of children who are diagnosed with gender dysphoria remain gender dysphoric as adults,” the proposal states. “There is a lack of quality evidence and certainly no conclusive research to support the medical transition of children to the opposite gender as a treatment for gender dysphoria.”