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West Virginia Medicaid Must Cover Trans Surgery, Judge Rules

Shauntae Anderson and Christopher Fain
From left: Shauntae Anderson and Christopher Fain courtesy Lambda Legal

Denial of the coverage "invidiously discriminates on the basis of sex and transgender status," a federal judge wrote.

West Virginia's Medicaid program can no longer deny coverage for gender-confirming surgery for transgender patients, a federal judge ruled Tuesday.

Lambda Legal, the Employment Law Center, and the law firm of Nichols Kaster had sued the state in 2020 on behalf of trans West Virginians, challenging the exclusion of such care from Medicaid and from the state employee health insurance plan. A settlement reached earlier this year led to the lifting of coverage restrictions from the state employees' plan, and now Medicaid will cover this care too. Medicaid is a joint federal-state health insurance program, administered by each state, primarily for low-income people.

"The same or similar surgical treatments are available to persons when the diagnosis requiring that treatment is not gender dysphoria," U.S. District Judge Robert C. Chambers wrote in his decision. The exclusion for treatment of gender dysphoria "invidiously discriminates on the basis of sex and transgender status," he continued.

The named plaintiffs in the suit were Christopher Fain and Shauntae Anderson, but the suit has class-action status, so the ruling will affect all trans West Virginians covered by Medicaid.

"This is a victory not only for me but for other transgender Medicaid participants across West Virginia," Fain said in a Lambda Legal press release. "This decision is validating, confirming that after years of fighting to prove that gender-confirming care is medically necessary, we should have access to the same services that West Virginia Medicaid already provides to cisgender participants. Transgender West Virginians should never feel as if our lives are worth less than others."

"I am excited to finally have access to the health care I deserve," Anderson added. "The exclusion negatively affects my health and well-being as well as the health and well-being of other transgender Medicaid participants in our community. Gender-confirming care is health care, and it is lifesaving."

"We applaud Judge Chambers's decision to remove the discriminatory barrier to accessing medically necessary, gender-confirming surgical care for all transgender West Virginia Medicaid participants," said Avatara Smith-Carrington, staff attorney at Lambda Legal. "Protecting and advancing health care for transgender people is vital, sound, and just. Transgender West Virginia Medicaid participants deserve to have equal access to the same coverage for medically necessary health care that cisgender Medicaid participants receive as a matter of course."

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