Story at a glance
- A federal judge on Friday ruled in favor of plaintiffs in a lawsuit that had asserted that North Carolina’s health plan for state employees “categorically deprived” transgender people of medically necessary gender-affirming care.
- The North Carolina State Health Plan (NCSHP) had denied enrollees coverage for counseling, hormone therapy, surgery and other affirming treatments, according to the lawsuit filed in 2019 by Lambda Legal and the Transgender Legal Defense & Education Fund (TLDEF).
- Earlier this year, the Department of Health and Human Services (HHS) said entities that restricted access to gender-affirming care may be in violation of Section 1557 of the Affordable Care Act.
A federal judge has ruled in favor of plaintiffs in a lawsuit challenging North Carolina’s state health plan, which has up until now excluded coverage for gender-affirming care — even if the same treatments are available to enrollees who are not transgender.
First filed in 2019 by Lambda Legal and the Transgender Legal Defense & Education Fund (TLDEF) on behalf of eight current and former state employees and their dependents, the lawsuit challenges the North Carolina State Health Plan (NCSHP) for “categorically depriving” transgender people of access to gender-affirming care, which health experts have said is medically necessary and often life-saving.
The NCSHP had denied those enrolled in the plan of coverage for care including counseling, hormone therapy, surgery and “any other health care provided in relation to a person’s transgender status and/or gender transition,” according to the lawsuit.
On Friday, a judge ruled that North Carolina’s health plan and state employees had violated both the Equal Protection Clause of the U.S. Constitution and Title VII of the Civil Rights Act of 1964 by “unlawfully discriminating based on sex and transgender status” and attempting to “create scientific controversy” about the efficacy of gender-affirming care.
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“Defendants’ belief that gender affirming care is ineffective and unnecessary is simply not supported by the record,” U.S. District Judge Loretta C. Biggs wrote Friday in her decision. “Consequently, their categorical sex and transgender-based exclusion of gender affirming treatments from coverage unlawfully discriminates against Plaintiffs.”
In guidance released earlier this year, the Department of Health and Human Services (HHS) declared that “categorically refusing to provide treatment to an individual based on their gender identity” amounted to “prohibited discrimination” under Section 1557 of the Affordable Care Act.
Entities receiving federal financial assistance, including the NCSHP, may also be in violation of Section 1557 if they restrict an individual’s ability to receive — or a doctor’s ability to provide — gender-affirming care on the basis of a person’s sex assigned at birth or gender identity.
According to Biggs, the suit’s defendants, identified as North Carolina State Treasurer Dale Folwell, Executive Administrator of the NCSHP Dee Jones, as well as several state employers, had tried to discredit mainstream science through testimony from “experts who mix their scientific analysis with hypothetical speculation and political hyperbole.”
“Issues surrounding transgender healthcare evoke strong emotional and political opinions,” Biggs wrote Friday. “But politics and emotion are not admissible as evidence in a court of law. Plaintiffs’ doctors, their experts, every major medical association, and Defendants’ own third-party administrators all agree that, in certain cases, gender affirming medical and surgical care can be medically necessary to treat gender dysphoria.”
Access to gender-affirming care, particularly for transgender and nonbinary youth, has been hotly debated this year in state legislatures across the country. In April, Alabama passed a first-of-its-kind felony ban on gender-affirming care for minors. That law was partially blocked by a federal judge last month, although school officials in the state are still required under the measure to inform parents if their children come out as transgender or nonbinary.
In a statement released Friday by Lambda Legal, Michael D. Bunting, Jr., the parent of a 17-year-old transgender boy and one of the plaintiffs in the lawsuit against North Carolina employers and the NCSHP, said for his child, gender-affirming care was “livesaving.”
“Struggling to secure essential care for your child, while watching them be targeted for discrimination, is devastating,” he said. “We hope that no other parent has to struggle this way in the future.”
Another plaintiff, Julia McKeown, an assistant professor at North Carolina State University, said the court’s decision represents an important and “powerful” victory for transgender North Carolinans.
“This decision sends a message of validation to the entire transgender community in North Carolina,” she said. “After years of fighting for fair treatment, finally having a court decide that these healthcare exclusions are wrong is vindicating.”
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