(WM) A federal lawsuit filed Nov. 12 alleges West Virginia’s Medicaid and state employee health plans unlawfully denied coverage for gender-confirming care for two transgender residents.
The suit argues the state is violating the Affordable Care Act and Medicaid law by not covering treatments for gender dysphoria.
Christopher Fain was denied coverage for his testosterone prescription under Medicaid, according to the complaint, after he was diagnosed with gender dysphoria in late 2018 and began transitioning to reflect his gender identity as a man. The 44-year-old paid for it out of pocket.
To avoid being misidentified as a woman and to treat his diagnosis, he also sought a bilateral mastectomy, but his Medicaid plan excludes it from coverage, the suit says.
A second plaintiff, Zachary Martell, is married to a state employee with health care coverage that similarly does not cover a bilateral mastectomy to treat his gender dysphoria and assist his transition.
In February 2019, the state health plan informed Martell it would not cover hormone replacement therapy through testosterone, about three months after his mental health provider recommended the treatment, according to the complaint.
The suit was filed by Lambda Legal, which has sued at least two other states for excluding gender-confirming care in state employee health plans, and two other groups.
The suit said the plaintiffs have “suffered emotional distress, stigmatization, humiliation and a loss of dignity” due to the health plans’ “targeted discrimination against transgender” individuals.
Healthcare.gov, the website for the Affordable Care Act, notes many health plans still exclude “services related to sex change” and says such exclusions “may be unlawful sex discrimination.”