State Medicaid Ordered To Pay For Gender Affirming Care
August 8, 2022A US District Court Judge ruled that West Virginia’s Medicaid program can no longer exclude gender-affirming medical care for its transgender members. The ruling will apply to the approximately 579,000 West Virginians enrolled in Medicaid, according to LGBTQ Nation.
The state’s Medicaid program has, since 2013, denied coverage for treatments associated with gender dysphoria or any services provided or performed in preparation for, or as a result of, "sex transformation surgery [sic]."
In November 2020, a class action lawsuit on behalf of two transmen, Christopher Fain and Zachary Martell, was filed by the LGBTQ+ advocacy organization Lambda Legal, attorney Nichols Kaster, and The Employment Law Center. Martell is in a same-sex marriage.
The state’s exclusions had meant the men were denied hormone replacement therapy and mastectomies and they had to pay for hormones. Furthermore, the lack of access to surgery and supportive therapy worsened their gender dysphoria.
Attorneys successfully argued that the exclusions violated the 1965 federal Medicaid Act, which states that “the medical assistance made available to any individual… shall not be less in amount, duration or scope than the medical assistance made available to any other such individual.”
West Virginia’s exclusions were also unlawful under federal constitutional and statutory guarantees of freedom from discrimination based on sex and gender, the men’s lawyers argued.
The judge agreed.
“We applaud Judge Chamber’s decision to remove the discriminatory barrier to accessing medically necessary, gender-confirming surgical care for all transgender West Virginia Medicaid participants. 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 healthcare that cisgender Medicaid participants receive as a matter of course,” Lambda Legal Staff Attorney Avatara Smith-Carrington said.
In response to the judge’s ruling, Fain said, “This is a victory not only for me but for other transgender Medicaid participants across West Virginia. 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.”
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