The Fourth Circuit Court of Appeals heard oral arguments about whether West Virginia’s ban on gender-affirming medical care for transgender adults under the state Medicaid program is discriminatory.
The appeals court judges also are considering if the state violates the Medicaid Act and the Affordable Care Act by not covering surgical treatments for gender dysphoria.
During the Dec. 9 oral arguments, attorneys argued Anderson v. Crouch, the case challenging West Virginia’s exclusions. The hearing lasted less than an hour.
Last year, the Fourth Circuit affirmed the trial court in the case by ruling that denying medically necessary healthcare to transgender adults is unlawful. But after the U.S. Supreme Court’s decision this summer in U.S. v. Skrmetti that upheld restrictions on care for minors, the Supreme Court vacated Anderson and sent it back to the Fourth Circuit for reconsideration.
During Tuesday’s arguments, Lambda Legal said U.S. v. Skrmetti does not decide Anderson v. Crouch, as this case concerns adults and the scientific literature supporting the standard of care is authoritative and unchanged.
Lambda Legal’s senior counsel said the Fourth Circuit should reaffirm its decision protecting transgender adults’ right to equal access to healthcare.
“The Fourth Circuit’s decision in Anderson was right the first time and is right today,” Omar Gonzalez-Pagan said. “Our clients are adults who have been denied coverage for essential medical care solely because they are transgender. The Supreme Court’s decision in U.S. v. Skrmetti dealt with a completely different law, distinct claims, and a different issue—restrictions on care for minors.
“Skrmetti should not affect the outcome in this case given that it has no application to the statutory claims at issue in this case. We are asking the Fourth Circuit to reaffirm its earlier ruling and ensure that transgender adults in West Virginia can access the healthcare they need.”
The state claims West Virginia’s exclusion does not violate equal protection because it is based on medical use, not sex or transgender status. It said the state is not required to fund gender-affirming surgery.
In its 2024 ruling, the U.S. Fourth Circuit Court of Appeals issued an 8-6 decision in favor of Shauntae Anderson, a transgender woman covered by West Virginia Medicaid who is seeking gender-affirming surgery. That followed a similar ruling in federal court by U.S. District Judge Robert C. “Chuck” Chambers.
West Virginia’s Bureau for Medical Services administers the state’s Medicaid Program and receives funding from the U.S. Department of Health and Huanm Services. West Virginia’s Medicaid program covers some gender-affirming care, including counseling, office visits, hormones and lab work but not gender-affirming surgery.
But Anderson’s attorneys note the state program partially or fully covers procedures such as mastectomies, breast-reduction surgery, chest reconstruction following a mastectomy, hysterectomies, removal or creation of the vagina and removal or creation of male reproductive organs.
Anderson began taking birth control pills for estrogen before going on Medicaid. Once on Medicaid, Anderson’s doctors recommended hormone replacement therapy, which she began in 2019.
Anderson says the coverage exclusion discriminates against transgender people in violation of the Equal Protection Clause of the Fourteenth Amendment, the Medicaid Act and the Affordable Care Act.
The three Fourth Circuit judges hearing the case are Paul Niemeyer from Maryland, Julius Richardson from South Carolina and Allison Jones Rushing from North Carolina.
