By John Riley on November 16, 2020 @JRileyMW
A transgender clothing store employee on Medicaid, a West Virginia state employee, and his transgender spouse have filed a class-action lawsuit against the Mountaineer State for its blanket exclusions that prohibit both the state’s Medicaid and employee health care plans from providing insurance coverage for gender-affirming health care.
The lawsuit, filed Thursday in the U.S. District Court for the Southern District of West Virginia, was brought by Lambda Legal, Nicholas Kaster, PLLP, and the Employment Law Center on behalf of Christopher Fain, a Medicaid participant, and Brian McNemar and Zachary Martell, a state employee and his dependent spouse, arguing that the blanket exclusion is discriminatory.
Fain, 44, who studies nonprofit leadership at Marshall University and works at a clothing store in Huntington, is enrolled in Medicaid, but has been denied coverage for his testosterone prescription due to the exclusion on transition-related care.
As a result, he has been forced to pay out-of-pocket for the prescription, creating additional financial hardship.
Martell, 33, a student at Mountwest College in Huntington, is married to Brian McNemar, an accountant at a state hospital.
Although McNemar’s health insurance plans his supposed to cover himself and any dependents, the exclusion barring coverage of “treatments associated with gender dysphoria” has resulted in the denial of coverage for Martell’s prescriptions and regular office visits with his health care provider.
Because of this denial of coverage, Martell and McNemar have either had to pay out-of-pocket expenses, or Martell has had to forego care altogether.
In its complaint, Lambda Legal argues that the exclusion violates the plaintiffs’ right to equal protection under the law by discriminating against transgender individuals seeking gender-affirming health care on the basis of both sex and transgender status.
It also alleges that the exclusion violates protections for transgender individuals contained in Section 1557 of the Affordable Care Act, as well as requirements within West Virginia’s Medicaid Act that dictate that coverage must be provided to all eligible individuals and that the coverage provided “not be less in amount, duration, or scope” than coverage provided to other Medicaid recipients.
The lawsuit, known as Fain v. Crouch, names the West Virginia Department of Health and Human Resources and its Bureau for Medical Services, which administers the Medicaid plan that provides insurance coverage to 564,000 Medicaid recipients, and The Health Plan of West Virginia, Inc., the health insurer for approximately 15,000 West Virginia state employees, as defendants.
Also named as defendants are William Crouch, the Cabinet Secretary of the West Virginia Department of Health and Human Resources, Cynthia Beane, the Commissioner for the Bureau for Medical Services, and Ted Cheatham, the chief administrative officer of the Public Employees Insurance Agency, in their official capacity as state officials who oversee the Medicaid and public employee health care plans.
See also: Georgia transgender sheriff’s deputy can sue for health care denial, court says
The plaintiffs and their lawyers are asking the court to issue both preliminary and permanent injunctions preventing the state from seeking to bar coverage for gender-affirming care, as well as a judgment that the exclusion is discriminatory and unconstitutional.
They are also seeking compensatory damages for any pain, suffering, humiliation, financial harm, or emotional distress the plaintiffs suffered as a result of being denied coverage, as well as payment of legal fees associated with having to bring the lawsuit.
“Transgender and non-binary West Virginians are denied coverage for essential, and sometimes life-saving, gender-confirming care — while cisgender West Virginians receive coverage for the same kinds of care as a matter of course,” Avatara Smith-Carrington, a Tyron Garner Memorial Fellow at Lambda Legal who serves as a lead attorney on the case, said in a statement. “The exclusions of gender-confirming care in West Virginia’s state health plans are unconstitutional and discriminatory, and deny transgender and non-binary West Virginians basic dignity, equality, and respect.”
“No one should have the door slammed on them while they’re just trying to access basic healthcare. But that’s what these discriminatory exclusions do to people just because they’re transgender,” Fain said in a statement. “This health care is about my very survival, and the health and survival of thousands of other transgender people in our community forced to go without care because of these exclusions. We feel like we are being swept under the rug, treated as if we don’t exist, and that is not okay.”
See also: Railroad employee health care plans agree to drop exclusions on transgender surgery
“It is both humiliating and painful to be denied access to coverage for essential healthcare simply because of who I am,” Martell added in his own statement. “For years, my husband has served as a dedicated public servant, and the health coverage we receive through the state employee health plan is a basic part of the compensation he earns through his job. The discriminatory exclusion, which bars me from care simply because I am transgender, denies state employees equal pay for equal work.”
Lambda Legal has previously been successful in fighting other blanket exclusions on gender-affirming care, securing a victory in March for an Alaska state librarian who was denied coverage for gender confirmation surgery under her state employee health care plan. That same month, a U.S. district court judge denied an effort by the state of North Carolina to dismiss a lawsuit brought by Lambda Legal on behalf of North Carolina state employees and their dependents who have been denied coverage for transition-related care.
“West Virginia shouldn’t single out certain communities to deny health care coverage,” Andrew Schneider, the executive director of the LGBTQ organization Fairness West Virginia, said in a statement. “These blanket exclusions are another hurdle that people shouldn’t have to jump over just to go to the doctor. The exclusions stop people from getting the care they need, which can be lifesaving. It’s time to ditch the exclusions and let doctors decide what care is best for their patients.”
Read more:
Parents of trans children sue Arizona over surgical requirement for changing gender markers
Trump supporter files restraining order over LGBTQ chalk art outside his home
Samuel Alito blasts gay marriage in speech to conservative legal society
By John Riley on March 24, 2025 @JRileyMW
U.S. Rep. Sarah McBride (D-Del.), the first openly transgender person ever elected to Congress, has reportedly cautioned Democrats about the need to foster conversations when it comes to engaging with those who have reservations about certain issues like transgender participation in sports.
"We have to create more space in our tent," McBride told NOTUS about how Democrats should approach people with reservations or genuine questions about transgender inclusion. "If, for instance, we want to have a majoritarian coalition -- not just electorally, but specifically on issues around trans rights -- that, by necessity, is going to have to include people who have a range of thoughts.
By John Riley on February 27, 2025 @JRileyMW
The Pentagon will start forcibly discharging transgender service members within 60 days unless an individual can obtain a special waiver to allow them to continue serving.
On Wednesday, February 26, the Pentagon issued a policy memo outlining how the U.S. Department of Defense is complying with an executive order by President Trump to prohibit transgender individuals from serving openly in the U.S. military.
Trump's executive order claims that allowing transgender people to serve in the Armed Forces threatens military readiness and undermines unit cohesion.
It contradicts a 2016 RAND Corporation study, commissioned by the Pentagon, that found allowing transgender members to serve openly had no negative impact on unit cohesion, operational effectiveness, or readiness.
By John Riley on March 5, 2025 @JRileyMW
President Donald Trump used his address to Congress on Tuesday, March 4, to attack transgender individuals, calling transgender identity a "lie" and railing against transgender athletes, gender-affirming care, and trans visibility in the military and more broadly within society.
At one point during the speech, Trump switched from speaking about a child who was diagnosed with cancer to claim his administration was protecting children from "toxic ideologies" in schools.
He brought up the story of January Littlejohn, a Florida anti-transgender activist who sued the Leon County School District in Tallahassee, Flordia, in 2021, alleging that her child's school had discussed restrooms and name change requests with the child, assisting her in "socially transitioning" without informing Littlejohn or her husband of their efforts.
These are challenging times for news organizations. And yet it’s crucial we stay active and provide vital resources and information to both our local readers and the world. So won’t you please take a moment and consider supporting Metro Weekly with a membership? For as little as $5 a month, you can help ensure Metro Weekly magazine and MetroWeekly.com remain free, viable resources as we provide the best, most diverse, culturally-resonant LGBTQ coverage in both the D.C. region and around the world. Memberships come with exclusive perks and discounts, your own personal digital delivery of each week’s magazine (and an archive), access to our Member's Lounge when it launches this fall, and exclusive members-only items like Metro Weekly Membership Mugs and Tote Bags! Check out all our membership levels here and please join us today!
Washington's LGBTQ Magazine
Follow Us:
· Facebook
· Twitter
· Flipboard
· YouTube
· Instagram
· RSS News | RSS Scene
Copyright ©2024 Jansi LLC.
You must be logged in to post a comment.