West Virginia taxpayers cannot be forced to pay for so-called “sex change surgeries,” the 4th Circuit Court of Appeals ruled on March 10.
A three-judge panel upheld the state’s prohibition on Medicaid paying for the permanently damaging procedures for both gender-confused minors and adults.
The court found the prohibitions are not a form of sex discrimination and do not violate the Equal Protection Clause.
Rather, the state allows procedures only for specific medical reasons, which it is allowed to do. For example, someone who is gender-confused can receive a hysterectomy for uterine cancer under the state’s Medicaid program but cannot receive one as an alleged treatment for gender dysphoria.
“Every person—regardless of that person’s sex, gender identity, or combination thereof—will be covered when seeking that service for a qualifying diagnosis,” Judge Julius Richardson wrote in the case Anderson v. Crouch. “And no person—regardless of that person’s sex, gender identity, or combination thereof—will be covered when seeking that service for a diagnosis that’s not on the list, such as gender dysphoria.”
Two Supreme Court decisions from last term formed the basis for this ruling. The court relied on U.S. v. Skrmetti, which affirmed that states can prohibit drugs and surgeries meant to make gender-confused minors look like the opposite sex.
West Virginia’s case was also bolstered by another ruling last term, Medina v. Planned Parenthood South Atlantic. That ruling confirmed states generally have broad powers to determine coverage and providers in their own Medicaid plans, and made it difficult for individuals to challenge such decisions.
Legal scholar Ed Whelan praised the decision in a commentary for National Review, calling it “outstanding.”
West Virginia Governor Patrick Morrisey also thanked the court for its ruling.
“I’m grateful the court recognized West Virginia’s authority to set reasonable limits on taxpayer-funded healthcare,” Morrisey stated in a news release. “States have a responsibility to manage public programs responsibly, and today’s ruling is an important victory for common sense and the taxpayers of West Virginia.”
The governor said the ruling backs the state’s other efforts to protect female spaces from gender-confused men.
West Virginia is currently waiting on a ruling from the Supreme Court on whether it can prohibit boys from competing in girls’ sports.
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