On Aug. 2, a federal judge ruled that West Virginia’s Medicaid program must cover gender-affirming surgical care for transgender patients.
U.S. District Court Judge Robert Chambers, of the Southern District of West Virginia, ruled that the insurance exclusion contained in the state’s Medicaid program — which prohibited coverage for gender confirmation surgery to treat gender dysphoria — discriminates against individuals on both their sex and their gender identity. He also issued an order prohibiting the state from attempting to enforce the exclusion by denying coverage to other transgender recipients.
In the case, known as Fain v. Crouch, Chambers found that such discrimination violates the Equal Protection Clause of the Fourteenth Amendment, anti-discrimination provisions contained in the Affordable Care Act, and provisions of the Medicaid Act that require Medicaid to cover medically necessary treatments and require that all Medicaid recipients receive access to the same type of coverage as other recipients.
“Defendants enacted a clear policy excluding coverage for surgical care of gender dysphoria with no exceptions. This caused an actual, concrete injury to plaintiffs by essentially constructing a discriminatory barrier between them and health insurance coverage,” Chambers wrote in his opinion. “This is not a hypothetical injury.
“Plaintiffs requesting coverage would have been futile due to the exceptionalness exclusion, and the law does not require Plaintiffs to take such futile acts,” Chambers added. “Defendants’ policy was clear — a request for coverage would have been denied under the exclusion. Thus, Plaintiffs have standing.”
The original plaintiffs in the lawsuit — Christopher Fain, a clothing store employee and Medicaid participant; and Brian McNemar, an accountant at a state hospital and his transgender spouse, student Zachary Martell — enlisted the help of Lambda Legal, the Employment Law Center, and the law firm Nicholas Kaster, PLLP, suing state officials in 2020 to challenge insurance exclusions in both West Virginia’s Medicaid program and its state employee health plans, as provided by the state’s Public Employee Insurance Agency.
In 2021, two additional plaintiffs, Shauntae Anderson, a warehouse worker and Medicaid recipient,, and Leanne James, a state employee, were successfully added to the lawsuit as plaintiffs. In 2022, a settlement with The Health Plan of West Virginia led to the removal of insurance exclusion on gender-affirming care in PEIA plans, with the remainder of claims regarding the PEIA being dismissed after James’ death in February 2022. The case continued, focusing on only the Medicaid exclusion.
The court also certified the lawsuit as a class action suit, meaning Judge Chambers’ findings apply to all transgender West Virginians who participate in the state’s Medicaid program, not just Anderson and Fain as individuals.
Fain and Anderson, as well as members of their legal team, praised Chambers’ ruling.
“We applaud Judge Chambers’ decision to remove the discriminatory barrier to accessing medically necessary, gender-confirming surgical care for all transgender West Virginia Medicaid participants,” Avatara Smith-Carrington, a staff attorney at Lambda Legal, said in a statement. “Protecting and advancing health care for transgender people is vital, sound, and just. Transgender West Virginia Medicaid participants deserve to have equal access to the same coverage for medically necessary healthcare that cisgender Medicaid participants receive as a matter of course.”
“I am excited to finally have access to the healthcare I deserve,” Anderson said in a statement. “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.”
“This is a victory not only for me but for other transgender Medicaid participants across West Virginia,” Fain noted. “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. Transgender West Virginians should never feel as if our lives are worth less than others.”
On Tuesday, April 16, a federal appeals court voted to block a West Virginia law banning transgender student-athletes from competing on teams that align with their gender identity.
The 4th U.S. Circuit Court of Appeals found that the ban, which was signed into law by Republican Gov. Jim Justice in April 2021, violates the rights of transgender students under Title IX, the federal statute that prohibits sex-based discrimination.
The law was challenged by a slew of civil rights and LGBTQ organizations on behalf of B.P.J., a 13-year-old transgender girl and middle school track and cross-country athlete who wishes to compete as a girl.
A Milwaukee school principal has been sued in federal court by a gay couple who allege he bullied, harassed, threatened, and assaulted their son for having two same-sex parents, violating the child's civil rights in the process.
The parents, referred to as M.P. and T.L. in the lawsuit, claim that Kasongo Kalumbula allegedly mistreated their son because of his family's makeup.
The lawsuit, filed last week in the U.S. District Court for the Eastern District of Wisconsin, asks for a jury trial and seeks an undetermined amount in damages.
It alleges that Kalumbula, who served as the assistant principal, and later, acting principal, of the Milwaukee French Immersion School from September 2018 to October 2021, physically and verbally abused the child -- who was in first grade when the harassment started -- and routinely singled him out for discipline.
Following her critically acclaimed performance as trans teen Jules Vaughn in Euphoria, Hunter Schafer says she no longer wants to play transgender roles.
Speaking with GQ magazine, the 25-year-old actress, who is herself transgender, noted that she has turned down "tons of trans roles" because she doesn't want to be typecast and prefers her gender identity not define the rest of her career.
"I don’t want to be that, and I find it ultimately demeaning to me and what I want to do," Schafer said. "I worked so hard to get to where I am, past these really hard points in my transition, and now I just want to be a girl and finally move on."
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