Court orders North Carolina, West Virginia to fund sex changes in state health care plans

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A federal court has ordered the governments of North Carolina and West Virginia to provide coverage for sex-change operations in state health care plans offered to state employees and through Medicaid.

The Fourth Circuit Court of Appeals — which has jurisdiction over North Carolina, West Virginia, South Carolina, Virginia, and Maryland — ruled in an 8-6 decision that refusing to provide coverage for transgender operations in state health care plans is discrimination “on the basis of gender identity and sex” in violation of the Equal Protection Clause.

The ruling claims policies in both states violate the Constitution and federal law. The North Carolina policy that the court found to be in violation excludes sex-change surgeries in its coverage for state employees. The West Virginia policy found to be in violation excludes sex-change surgeries in its Medicaid coverage.

According to the majority opinion, written by Chief Judge Roger Gregory, the policies in both states are based on “a gender stereotype.” He used mastectomies (operations to remove breasts) as an example, suggesting that the stereotype is “the assumption that people who have been assigned female at birth are supposed to have breasts, and that people assigned male at birth are not.”

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