Exclusion of Transgender Care from West Virginia State Health Insurance Coverage Is Discriminatory, Class Action Says

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West Virginia’s Department of Health and Human Resources, Bureau for Medical Services and its cabinet secretary are among the defendants in a proposed class action that alleges the state’s health insurance plan discriminatorily deprives transgender individuals of essential, and sometimes life-saving, healthcare. 

According to the 39-page lawsuit, West Virginia’s state Medicaid and employee health plans “facially” and “categorically” exclude from coverage healthcare needed by transgender people and include language that the plaintiffs say is antiquated, improper and unmistakably targets transgender residents on explicitly sex-based terms. 

More specifically, West Virginia’s state health plans categorically deny transgender individuals coverage for gender-confirming care, which includes, but is not limited to, counseling, hormone replacement therapy and surgical care, the complaint says. 

“While cisgender people receive coverage for those forms of health care as a matter of course, transgender people are targeted for discrimination by exclusions in the state health plans,” the plaintiffs allege. “This kind of discrimination is unlawful under federal constitutional and statutory guarantees of freedom from discrimination based on sex and transgender status.” 

The state’s exclusion of transgender individuals from insurance coverage amounts to a “sweeping, uniform denial of care for all transgender people,” the complaint says. 

According to the lawsuit, the defendants, among whom are West Virginia Department of Health and Human Resources Cabinet Secretary William Crouch, West Virginia Bureau for Medical Services Commissioner Cynthia Beane, West Virginia Public Employees Insurance Agency Director Ted Cheatham and the Health Plan of West Virginia, Inc., violate the law in two ways.

First, the complaint reads, the defendants categorically deny coverage for gender-confirming care to low-income transgender Medicaid participants, even though the treatment can be medically necessary and life-saving, while “routinely providing cisgender participants the same treatments.” The suit explains gender-confirming care is the treatment for gender dysphoria, the clinically significant distress that can result from the dissonance between one’s gender identity and their sex assigned at birth.

Second, the lawsuit alleges the defendants discriminate against state employees in West Virginia and their dependents by denying coverage for gender-confirming care even though cisgender residents receive the same kinds of treatments “as a matter of course.” According to the case, West Virginia provides, as part of its compensation for employment, health insurance coverage for employees and their eligible dependents through the Public Employees Insurance Agency (PEIA), yet all health plans made available through the PEIA deny coverage for gender-confirming care and thereby unlawfully discriminate against those who are transgender or have transgender family members who depend on them for health insurance. 

“In other words, Defendants deny equal compensation for equal work to employees who are transgender or have transgender dependents, and harm employees’ transgender family members who depend on them for health,” the plaintiffs allege, charging that the blanket gender-confirming care exclusions are stated expressly in both West Virginia’s Medicaid and state employee health plans. 

“While phrased in slightly differently terms across the plans, the exclusions all single out transgender people for differential treatment and rely explicitly on sex-based considerations,” the suit claims. 

The plaintiffs say West Virginia’s exclusion of gender-confirming care from insurance coverage “[flies] in the face of the medical consensus” that the treatment is the sole safe and effective medical treatment for gender dysphoria and wholly disregards the harm of denying transgender individuals access to critical healthcare. West Virginia’s coverage denials for transgender people “expose a particularly vulnerable group to significant and avoidable harms to their health and wellbeing,” as well as inflict “needless suffering and financial hardship” in violation of the United States Constitution and federal law. 

The lawsuit looks to represent a class of all transgender people enrolled in West Virginia Medicaid and who are seeking or will seek gender-confirming care barred by the state’s exclusions. The case also looks to cover a class of all individuals who are enrolled in a state employee health plan and who are either transgender and have sought or will seek gender-confirming care barred by West Virginia’s exclusions, as well as dependents meeting the same description.   

The suit also proposes to cover a subclass consisting of all West Virginia employees who are enrolled in a state health plan. 

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