A federal appeals court ruled that North Carolina’s state health insurance plan discriminated against transgender patients by not covering gender-affirming care.
Transgender state workers sued the state in 2019 over a coverage exclusion in the State Health Plan for treatments for gender dysphoria, the medical term for distress occurring when someone’s physical sex doesn’t match their gender identity.
The 4th Circuit U.S. Court of Appeals sided with the workers on Monday, finding that the exclusion violated the Equal Protection Clause of the U.S. Constitution by discriminating on the basis of gender identity and sex.
The case could be appealed to the U.S. Supreme Court.
Defendants in the case, which included state Treasurer Dale Folwell, argued that the exclusion did not specifically target transgender people because it applied to everyone diagnosed with gender dysphoria.
“In this case, discriminating on the basis of diagnosis is discriminating on the basis of gender identity and sex,” Judge Roger Gregory wrote in the majority opinion.
“Gender dysphoria is so intimately related to transgender status as to be virtually indistinguishable from it,” Gregory wrote. “The excluded treatments aim at addressing incongruity between sex assigned at birth and gender identity, the very heart of transgender status.”
The State Health Plan covers over 740,000 public employees and their dependents.
The North Carolina General Assembly passed several laws targeting transgender people last year, including a ban on gender-affirming care for minors and a ban on transgender women’s participation in women’s sports.