West Virginia Medicaid recipients and Fain v. Croch plaintiffs Shauntae Anderson (left) and Chris Fain – Photos courtesy of Lambda Legal.
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.”
The Boy Scouts of America is rebranding itself to be more inclusive of people of different genders and sexual orientations.
On May 7, the 114-year-old Irving, Texas-based organization announced it would change its name to Scouting USA, a nod to its recent expansion and acceptance of girls into its ranks.
"In the next 100 years we want any youth in America to feel very, very welcome to come into our programs," Roger Krone, the organization's president and CEO, told The Associated Press in an interview ahead of the announcement.
The name change will officially take effect on February 8, 2025, to coincide with the organization's 115th anniversary.
A Missouri appeals court ruled that a transgender man is entitled to more than $4 million in damages for discrimination after being barred from the boys' locker room when he was enrolled in public school over a decade ago.
Missouri's Western District Court of Appeals unanimously reversed a lower court's decision to throw out a jury verdict in favor of R.J. Appleberry, referred to in court documents as "R.M.A."
Appleberry was a former student of Delta Woods Middle School, the Freshman Center, and Blue Springs South High School in Blue Springs, Missouri.
Writing for the appeals court, Judge Anthony Gabbert wrote that the Blue Springs R-IV School District had discriminated against the former student by barring him from boys' facilities, reports the Missouri Independent.
Lia Thomas, the former University of Pennsylvania swimmer who became the first transgender woman to win an NCAA title, has lost her challenge to overturn a policy banning transgender female athletes from competing as women in elite competitions.
The Court of Arbitration for Sport dismissed Thomas's request for arbitration with World Aquatics, the governing body in swimming and diving events, effectively dashing any hope she had of competing in the Olympics or elite global competitions, reports The New York Times.
The Lausanne, Switzerland-based international body, established to settle disputes related to elite sporting competitions, ruled that Thomas did not have standing to bring the case because she was not a member of its member federation -- USA Swimming -- prior to bringing her challenge.
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