Judge Rules West Virginia’s Medicaid Program Must Provide Gender-Affirming Care

West Virginia must provide gender-affirming care to its transgender residents through the state Medicaid program, a federal judge ruled this week.

On Tuesday, U.S. District Judge Chuck Chambers found that the state was discriminating against transgender residents with low incomes by excluding gender-affirming care — which can consist of therapy, medication or surgery — from its Medicaid program.

Two transgender West Virginia residents, Shauntae Anderson and Christopher Fain, sued the state over the policy in federal court. They were represented by Lambda Legal, a legal organization that focuses on LGBTQ issues.

While cisgender people receive care without regard to their sex or identity, “transgender people are targeted for discrimination by exclusions in the state health plans,” Lambda Legal said in its lawsuit filed last fall.

“This kind of discrimination is unlawful under federal constitutional and statutory guarantees of freedom from discrimination based on sex and transgender status,” the organization went on.

Chambers sided with that argument, ruling that transgender recipients of West Virginia’s Medicaid program were being treated unfairly under the policy.

“Transgender people have access to the same surgeries for other diagnosis — the exclusion [by the state] is aimed specifically” at gender-affirming treatments, Chambers wrote in his opinion. “Thus, the exclusion targets transgender people because they are transgender.”

The policy violates the Equal Protection clause of the 14th Amendment, as well as provisions within the Affordable Care Act and the Medicaid Act, the judge said.

The argument laid out by the state — that gender-affirming care is not medically necessary — is also “wholly unsupported by the record, and importantly, is refuted by the majority of the medical community,” Chambers said.

The two litigants in the lawsuit celebrated their legal victory.

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

Fain said that the decision confirms “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.”

Gender-affirming care is indeed life-saving, lawyer and trans activist Chase Strangio noted in an op-ed for Truthout in December. “My personal experience of this care being life-saving is echoed in decades of data,” Strangio said. “When trans people are able to access the gender-affirming health care that we need, our mental health improves dramatically.”

“Science, medicine and the testimonial experiences of thousands of trans people over decades all show this care to be safe and effective,” he added.