north Carolina Appeals to Supreme Court Over Transgender Healthcare Coverage Ban
North Carolina is appealing a federal court decision that struck down its state health plan’s exclusion of medically necessary gender-affirming care for transgender individuals. The case, currently before the US supreme Court, centers on whether the North Carolina State Health Plan for Teachers and State Employees’ coverage rules violate the Equal Protection Clause or other federal laws.
The dispute began with a challenge to the plan’s long-standing policy of excluding coverage for treatments “leading to or in connection with sex changes or modifications.” State officials argue this exclusion, like others within the plan (covering cosmetic services, experimental treatments, and psychological surgery, for example), is a cost-saving measure designed to benefit all 740,000 members.
However, the 4th US Circuit court of Appeals ruled 8-6 in April 2024 against the state, tossing out the ban on coverage for sex-change surgeries and related treatments. Judge Roger Gregory,writing for the majority,stated,”Do healthcare plans that cover medically necessary treatments for certain diagnoses but bar coverage of those same medically necessary treatments for a diagnosis unique to transgender patients violate either the Equal Protection Clause or other provisions of federal law? We hold that they do.”
The state contends the 4th Circuit’s decision is flawed, arguing the plan distinguishes between treatments, not based on any protected characteristic. They filed a petition with the Supreme Court in July 2024, asserting the ruling “deviates” from legal tradition and “deepens a conflict among the courts of appeals” regarding scrutiny of laws impacting gender-affirming care.
According to a brief filed by the respondents, both North Carolina and West virginia’s state health plans “categorically exclude medically necessary gender-affirming care for transgender recipients,” despite offering the same treatments to cisgender members, even for gender-affirming reasons. The brief further highlights the potential consequences of denying this care, stating untreated gender dysphoria can lead to “depression, self-injury, and even suicide.”
Twenty-four states filed a brief in August 2024 supporting North Carolina and West virginia’s appeals. The 4th Circuit had previously ruled against West Virginia in a similar case. The Supreme Court will now consider whether to uphold the 4th Circuit’s injunction preventing North Carolina from excluding coverage for gender-affirming treatments.
