Judge rules West Virginia Medicaid must cover gender-affirming medical care – The Hill

The story at a glance


  • West Virginia’s Medicaid program will no longer exclude coverage for gender-affirming medical care, a federal judge ruled Tuesday.

  • Lambda Legal, Nichols Kaster Law Firm, PLLP, and Employment Law Center, PLLC filed a class action lawsuit in 2020 challenging West Virginia’s exclusion from coverage for gender-affirming surgeries for transgender beneficiaries of Medicaid.

  • West Virginia was one of nine states whose Medicaid program explicitly excluded coverage for gender-affirming health care.

West Virginia’s Medicaid program can no longer exclude coverage for gender-affirming surgical care for transgender beneficiaries, a federal judge ruled this week.

In a decision released WednesdayDistrict Court Judge Robert C. Chambers wrote that West Virginia Medicaid’s refusal to cover gender-affirming surgeries for the treatment of gender dysphoria “unduly discriminates on the basis of gender and transgender status.”

Chambers said the categorical exclusion of transgender health care violated the Equal Protection Clause of the 14th Amendment, the Affordable Care Act and the Medicaid Act.

The decision stems from a class action filed in 2020 by Lambda Legal on behalf of two transgender men who were denied coverage for gender-affirming medical care under the state’s Medicaid program and the West Virginia State Employees’ Health Plan .


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The lawsuit argued that the intentional exclusion from transgender health care coverage was “unmistakable,” especially since treatments like hormone therapy were covered by Medicaid for cisgender program recipients who did not use them to the “gender transition procedures”.

In 2021, two other plaintiffs – Shauntae Anderson, a Medicaid recipient, and Leanne James, a civil servant and member of the Public Employee Insurance Agency (PEIA) – join the trial.

Earlier this year, a settlement with The Health Plan of West Virginia, Inc. led to the removal of the gender-confirming healthcare coverage exclusion from its PEIA plans. The remaining claims involving PEIA were dismissed following James’ death in February.

“I am thrilled to finally have access to the health care I deserve,” Anderson said Wednesday in a statement published by Lambda Legal. “Gender confirmation care is health care, and it saves lives.”

Christopher Fain, another plaintiff in the lawsuit, said Tuesday the decision represents a victory not only for himself, but also for transgender Medicaid recipients across the state.

“West Virginia trans people should never feel like our lives are worth less than others,” he said.

West Virginia had been one of nine states whose Medicaid program explicitly excludes coverage for gender-affirming health care. Exceptions include Ohio, where officials said the ban is not enforcedand Arkansas, whose 2021 Medicaid ban only applies to minors.

The Georgia Department of Community Health agreed earlier this month to include coverage for gender-affirming surgeries in the state’s Medicaid program after the American Civil Liberties Union (ACLU) and its Georgian affiliate sued the department.

The Florida Agency for Health Care Administration (ACHA) is currently considering blocking the state’s Medicaid program from covering gender-affirming medical care, including puberty blockers, hormones, surgeries affirmation or “any other procedure that alters primary or secondary sex characteristics” when these interventions are used to treat gender dysphoria.

Posted on August 04, 2022