West Virginia court rules that gender-affirming surgery should be paid for by tax payer, in landmark decision

Gender-affirming surgery must be paid for by state healthcare plans, a Richmond court has ruled.

The federal appeals court is the first in the country to say that transition should be covered for transgender people with government-sponsored insurance.

The decision arose out of a set of cases in North Carolina and West Virginia, in which transgender residents argued that their surgeries should be funded by either employee health plans or state-subsidized Medicaid.

State officials said that their policy of not covering transgender surgeries was based on financial concerns and not bias.

But the Richmond-based 4th US Circuit Court of Appeals ruled 8-6 in the case on Monday.

The courts decision does not mean that transition will automatically be covered for transgender people with government-sponsored insurance. The ruling could be appealed in the Supreme Court, which recently allowed Idaho to enforce a ban on gender-affirming care for minors. 

But the powerful Court has been somewhat unwilling to engage on the issue and has allowed multiple 4th Circuit rulings supporting transgender rights stand.

In West Virginia, transgender Medicaid users challenged the state’s policy, which has by law banned the funding of ‘transsexual surgeries’ since 2004. 

In North Carolina, state employees challenged their coverage which has not covered surgeries for gender dysphoria since 2018.

In January, Ohio become the 23rd state to ban transgender care for minors, amid a wave of laws passed by Republican-controlled legislatures in recent years.

‘The coverage exclusions discriminate on the basis of sex and gender identity, and are not substantially related to an important government interest,’ Judge Roger Gregory, first appointed by former President Bill Clinton and re-appointed by former President George W. Bush, wrote in the majority opinion.

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