On March 10, in a first-of-its-kind ruling, the U.S. 4th Circuit Court of Appeals escalated attacks on transgender individuals by upholding West Virginia’s restriction on surgical procedures that aid in gender affirmation, setting a precedent for other states to follow suit.
According to Reuters, more than a dozen U.S. states currently prohibit or limit the use of Medicaid coverage for gender-affirming care, and the 4th Circuit has become the first federal appeals court to enforce that type of law.
The specific surgeries and procedures the West Virginia law seeks to remove from Medicaid coverage includes physical alterations that align with one’s gender identity such as chest reconstruction and facial procedures.
This unanimous decision, coming from a three-judge panel of the 4th U.S. Circuit Court of Appeals in Richmond, Virginia, overturned a 2024 decision ruling the statute as discriminatory and a constitutional violation. The 4th Circuit panel argued that the law applies to specific procedures, not specific individuals, and does not illegally discriminate against transgender people.
In the 35-page ruling, Trump-appointee Judge Julius Richardson wrote, “It is not irrational for a legislature to encourage citizens to appreciate their sex and not become disdainful of their sex by refusing to fund experimental procedures that may have the opposite effect.”
The Federal Trade Commission, which enforces consumer protection laws, is investigating medical groups over their support for gender-affirming treatments, an action the groups are calling unlawful retaliation for their constitutionally protected speech.
