West Virginia Medicaid must cover gender-affirming surgeries, judge rules

A federal judge has ruled that West Virginia's Medicaid program cannot exclude coverage for gender-affirming surgeries.

Driving the news: District Judge Robert C. Chambers wrote in a 30-page ruling that the exclusion "discriminates on the basis of sex and transgender status," and certified the lawsuit, filed by Lambda Legal, as a class action covering all trans people who rely on West Virginia's Medicaid.

Details: West Virginia Department of Health and Human Resources had maintained that its program does not discriminate on the basis of identity, but Chambers noted in his ruling on Tuesday that "the exclusion is aimed specifically at a gender change procedure."

• He pointed out that trans people can access the same surgeries when the diagnosis is not related to gender dysphoria. "Thus, the exclusion targets transgender people because they are transgender."
• The exclusion, which he said violates the Equal Protection Clause of the 14th Amendment, the Affordable Care Act and the Medicaid Act, "denies surgical care to all transgender people who may seek surgery to treat gender dysphoria—that subset of transgender people is equally protected against discrimination."
• Chambers, a Clinton appointee, also dismissed the claim that gender-affirming surgeries are not medically necessary, saying the argument is "wholly unsupported by the record, and importantly, is refuted by the majority of the medical community."

What they're saying: "I am excited to finally have access to the healthcare I deserve. 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,” said Shauntae Anderson, a plaintiff in the lawsuit, said in a statement.

• "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," added Christopher Fain, another plaintiff. 

• "Transgender West Virginians should never feel as if our lives are worth less than others."

The big picture: West Virginia isn't the only state that has tried to enact an exclusion for coverage. Florida Gov. Ron DeSantis (R) has pushed forward with his effort to ban gender-affirming care for Medicaid users.

Meanwhile, more Republican-led states are moving to ban gender-affirming care for trans youth despite the Justice Department's warning that such actions are barred by the 14th Amendment's Equal Protection Clause.

• The West Virginia Department of Health and Human Resources did not immediately return Axios' request for comment.