The United States Court of Appeals for the Fourth Circuit has issued a ruling in Kadel, et al. v. Folwell, et al. Case No. 22-1721 that gender-affirming care to treat gender dysphoria cannot be denied that the failure to provide such coverage is discriminatory and violates the 14th Amendment’s Equal Protection Clause and provisions of federal law, including the Medicaid Act and the Affordable Care Act.

The cases originated in North Carolina, Kadel v. Folwell, and West Virginia, Anderson v. Crouch. In these states, officials excluded coverage of gender-affirming care from the state-employee health plan and from Medicaid.

It is possible that the claimants will appeal this decision to the Supreme Court. In the meantime, the decision is binding in Maryland, Virginia, West Virginia, North Carolina and South Carolina.

As discussed in last month’s Benefit Beat, regulations have been issued that broadly address inequity across health care, underscoring the importance of not discriminating based on sex. The regulations are expected to take effect on July 5, 2024.

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