A federal appeals court will hear oral argument today on a federal judge’s order that required the State Health Plan to pay for medical treatments, including hormone therapy and surgeries, for transgender individuals.
The hearing by the Fourth Circuit appeals court in Richmond is slated to begin at 9 a.m.
Judge Loretta Biggs of the Middle District of North Carolina ruled June 10 in favor of plaintiffs, who included several transgender people and their parents. Biggs’ order required the state’s health plan to resume coverage that day.
State Treasurer Dale Folwell, who oversees the state health plan, is a defendant in the case.
The case Kadel v. Folwell was filed by Lambda Legal and the Transgender Legal Defense & Education Fund in March 2019 on behalf of several current and former state employees and their children who were denied coverage for medically necessary care under the State Health Plan.
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The State Health Plan is North Carolina’s largest purchaser of medical and pharmaceutical services. It covers nearly 740,000 teachers, the governor, current and former legislators, state university and community college personnel and their dependents as well as non-Medicare retirees and their dependents.
Folwell said in July the State Health Plan’s board announced it would no longer exclude treatments connected with “sex transition or modifications.”
“I’ve always said that if the legislature or the courts tell me we have to provide for sex transition operations and treatments, I would,” Folwell said.
However, Folwell and the State Health Plan board claim Biggs’ order “deprived the Plan of the benefit of a jury trial, where experts could transparently debate whether sex transition operations are or are not medically necessary.”
On Tuesday, Folwell said the State Health Plan board “has always had the authority to set benefits that do the most good for the most amount of our members.”
“This lawsuit is about requiring taxpayers to fund sex transition procedures. The facts are on our side, and we hope the Fourth Circuit will apply the law and reverse Judge Biggs’ decision.”
According to a statement from Folwell, the state health plan’s refusal to cover surgical and hormonal treatments related to the diagnosis of gender dysphoria dates back to the 1990s.
In December 2016, Treasurer Janet Cowell and the health plan board voted to allow coverage for a year, citing projected federal regulatory changes.
The board vote took place three weeks before Folwell began his first term as treasurer on Jan. 1, 2017.
Biggs determined the SHP’s refusal to cover medical care related to gender transition “discriminates based on sex and transgender status in violation of the Equal Protection Clause of the U.S. Constitution and discriminates because of sex in violation of Title VII” of the federal Civil Rights Act.
“Defendants are … ordered to reinstate coverage for ‘medically necessary services’ for the treatment of gender dysphoria. The issue of damages is reserved for trial.”
Folwell has said his stance on excluding gender transition care from the state health plan is part of his overall effort “to lower health care costs for those that teach, protect and otherwise serve.”
“This case has always been about protecting the authority of the board to sustain the plan for current, future and retired members, and nothing else,” he said.