Victory! Court Rules for Transgender West Virginia Medicaid Participants Denied Health Care Coverage

Today, federal District Court Judge Robert C. Chambers ruled that West Virginia’s Medicaid program could no longer discriminate by excluding coverage for gender-confirming surgical care for transgender West Virginia Medicaid participants.  

The ruling came in a lawsuit filed by Lambda Legal, Nichols Kaster, PLLP, and the Employment Law Center, PLLC challenging West Virginia’s exclusion of coverage for gender-confirming surgical care.  

“We applaud Judge Chamber’s decision to remove the discriminatory barrier to accessing medically necessary, gender-confirming surgical care for all transgender West Virginia Medicaid participants. Protecting and advancing health care for transgender people is vital, sound, and just. Transgender West Virginia Medicaid participants deserve to have equal access to the same coverage for medically necessary healthcare that cisgender Medicaid participants receive as a matter of course,” said Avatara Smith-Carrington, Staff Attorney at Lambda Legal. 

The court also certified the lawsuit as a class action, covering all transgender West Virginians who participate in Medicaid. 

“I am excited to finally have access to the healthcare I deserve. The exclusion negatively affects my health and wellbeing as well as the health and wellbeing of other transgender Medicaid participants in our community. Gender-confirming care is healthcare, and it is lifesaving,” said plaintiff  Shauntae Anderson, West Virginia Medicaid participant.  

“This is a victory not only for me but for other transgender Medicaid participants across West Virginia. This decision is validating, confirming that after years of fighting to prove that gender-confirming care is medically necessary, we should have access to the same services that West Virginia Medicaid already provides to cisgender participants. Transgender West Virginians should never feel as if our lives are worth less than others,” said plaintiff Christopher Fain, West Virginia Medicaid participant. 

Background: 

Lambda Legal, Nichols Kaster, PLLP, and the Employment Law Center, PLLC filed the class action lawsuit, Fain v. Crouch, in 2020 on behalf of Christopher Fain, a Medicaid participant; and Zachary Martell, the spouse of Brian McNemar, a state employee, challenging the exclusion of gender-confirming care in both the Medicaid and state employee health plans respectively. In 2021, counsel added two additional plaintiffs, Shauntae Anderson, a Medicaid participant, and Leanne James, a public employee and Public Employee Insurance Agency (PEIA) member. 

In 2022, a settlement with The Health Plan of West Virginia, Inc. led to the removal of the exclusion on coverage for gender-confirming care in The Health Plan’s PEIA plans. The remaining claims involving PEIA were dismissed after the sorrowful passing of Leanne James in February 2022.   

Avatara Smith-Carrington, Tara Borelli, Carl Charles, Sasha Buchert, and Nora Huppert are handling the matter for Lambda Legal. They are joined by Anna Prakash and Nicole Schladt of Nichols Kaster, PLLP; and Walt Auvil of the Employment Law Center, PLLC. 

Learn more about the case:  https://www.lambdalegal.org/in-court/cases/fain-v-crouch 

Read the main decision here: https://www.lambdalegal.org/in-court/legal-docs/fain_wv_20220802_opinion-and-order-denying-to-exclude 

Read the decision granting the plaintiff's motion for class certification here: https://www.lambdalegal.org/in-court/legal-docs/fain_wv_20220802_opinion-and-order-granting-motion