Judge Rules NC Health Plan Must Cover Transgender Treatments

Carolyn Crist

June 13, 2022

A federal judge ruled that the North Carolina state employee health plan unlawfully discriminated by excluding services for transgender people and not covering hormone therapy and surgeries, as it once did.

U.S. District Judge Loretta Biggs ruled in favor of transgender employees and parents of transgender children in saying the plan must cover the services, according to The Associated Press. Biggs noted that refusing coverage for gender-affirming services violates the Equal Protection Clause of the U.S. Constitution and Title VII of the Civil Rights Act of 1964.

Biggs ordered the state health plan to resume coverage of "medically necessary services for the treatment of gender dysphoria," which occurred briefly in 2017. Monetary damages will be considered in a trial set to begin next month, the AP reported.

"This decision sends a message of validation to the entire transgender community in North Carolina," Julia McKeown, an assistant professor of education at North Carolina State University, said in a statement from Lambda Legal, which provided representation.

"After years of fighting for fair treatment, finally having a court decide that these health care exclusions are wrong is vindicating," McKeown said. "As government employees, all we want is equal access to health care, but we were denied just because we are transgender."

The state health plan provides medical coverage for nearly 750,000 teachers, state employees, retirees, and their dependents, the AP reported. Lambda Legal and the Transgender Legal Defense & Education Fund filed the lawsuit, Kadel v. Folwell, in 2019 on behalf of several current and former state employees and their dependents.

State Treasurer Dale Folwell, whose office oversees the state health plan, took office in early 2017 and canceled the coverage. The lawsuit sued Folwell, along with the health plan, its top executive, and other government entities.

Folwell's office is still reviewing the ruling, the AP reported, and Folwell said the board of trustees has had the ability to set benefits for decades. He also told the AP that he had hoped the judge would "trust the people of North Carolina to have a jury trial on whether taxpayers should be paying for sexual transition operations."

In contrast, Biggs wrote that the plaintiffs' doctors and experts, as well as medical associations and the plan's third-party administrators, agreed that the services "can be medically necessary to treat gender dysphoria in some cases."

"Defendants' belief that gender-affirming care is ineffective and unnecessary is simply not supported by the record," she said.

The U.S. Department of Health and Human Services finalized a regulation in 2016 that banned coverage exclusions related to gender transition, the AP reported. Biggs didn't rule on Friday whether the state plan's actions violated the health care nondiscrimination law, known as Section 1557 of the Affordable Care Act.

Sources

The Associated Press: "Judge: NC health plan must cover transgender treatments."

Lambda Legal: "Victory! Court Rules for Transgender North Carolina State Employees Denied Health Care Coverage."

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