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North Carolina Can't Deny Health Care to Trans State Workers

Max Kadel and Julia McKeown
From left: Max Kadel and Julia McKeown courtesy Lambda Legal/TLDEF

The exclusion of coverage for gender-affirming health care is illegal discrimination, a federal judge ruled Friday.

The state of North Carolina illegally discriminated against transgender employees by excluding gender-affirming treatment from their health care plans, a federal court ruled Friday.

The blanket exclusion of such care for state workers is discrimination based on sex and transgender status, and it violates the U.S. Constitution's guarantee of equal protection of the laws and the sex discrimination ban in Title VII of the Civil Rights Act of 1964, Judge Loretta Biggs ruled in U.S. District Court for the Middle District of North Carolina. State insurance plans must begin providing the coverage, she wrote.

Her decision came in the case of Kadel v. Folwell, in which several current and former state employees and their dependents sued after the North Carolina State Health Plan, which covers state workers, denied coverage for their medically necessary gender-affirming care. They are represented by Lambda Legal and the Transgender Legal Defense and Education Fund. Folwell is Dale Folwell, the state treasurer.

The state had tried to claim it was protected from lawsuits due to sovereign immunity, "the legal doctrine that precludes bringing a lawsuit against the state without its consent," as Lambda Legal explains. But the U.S. District Court and a federal appeals court had rejected that argument, and the U.S. Supreme Court declined to review it, therefore allowing the suit to proceed. Judge Biggs's decision comes just five months after the Supreme Court let the case go forward.

"I am thrilled beyond measure for this powerful victory not only for myself but other transgender employees across the state," Julia McKeown, an assistant professor in the College of Education at North Carolina State University, said in a Lambda Legal press release. "This decision sends a message of validation to the entire transgender community in North Carolina. After years of fighting for fair treatment, finally having a court decide that these health care exclusions are wrong is vindicating. As government employees, all we want is equal access to health care, but we were denied just because we are transgender."

Other plaintiffs were Max Kadel, Sam Silvaine, and Dana Caraway, plus two sets of parents of trans children, Michael and Shelley Bunting and Jason Fleck and Alexis Thonen. "Like all parents, all we wanted for our child was lifesaving, medically necessary health care," said Michael Bunting, who works for the University of North Carolina at Chapel Hill, said in the release. "Struggling to secure essential care for your child, while watching them be targeted for discrimination, is devastating. We hope that no other parent has to struggle this way in the future."

"We celebrate this decision as a significant step toward expanding access to nondiscriminatory health care for the transgender public servants in North Carolina," added Tara Borelli, senior counsel at Lambda Legal. "We are pleased that the court has recognized this exclusion of medically necessary care to transgender state employees as unlawful discrimination. North Carolina was on the wrong side of history, and we hope it closes this unfortunate chapter."

"Gender-affirming health care is essential health care. We are thrilled to know that moving forward our clients and other transgender North Carolina state employees and state employees with transgender dependents will finally have access to this lifesaving care," said David Brown, legal director at TLDEF.

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