Fourth Circuit ruling upholds Medicaid coverage for gender-affirming care in U.S.

The United States Court of Appeals for the Fourth Circuit has issued an en banc ruling affirming district court decisions that found attempts by states to deny coverage for gender-affirming care violate the 14th Amendment’s Equal Protection Clause and provisions of federal law, including the Medicaid Act and the Affordable Care Act.

The ruling stemmed from two cases in North Carolina (Kadel v. Folwell) and West Virginia (Anderson v. Crouch), where state officials excluded coverage of gender-affirming care from the state-employee health plan and from Medicaid, respectively. The U.S. Court of Appeals for the 4th Circuit found that the exclusions impermissibly discriminated against transgender individuals seeking treatment.

“Coverage of gender-affirming care is not optional in state Medicaid programs, and we are relieved that the Fourth Circuit has affirmed that position,” said Catherine McKee, senior attorney at the National Health Law Program. “All individuals enrolled in Medicaid, including transgender individuals, are entitled to medically necessary health care.”

The National Health Law Program submitted an amicus in Anderson. NHeLP partners with Lambda Legal, counsel in Kadel and Anderson, to continue to fight state attempts to restrict access to gender-affirming care in Medicaid, including through ongoing litigation in Florida and North Carolina.