State health care plans and government-funded insurance programs cannot exclude coverage for gender-affirming medical care, a federal appeals court ruled Monday. The 4th U.S. Circuit Court of Appeals ruled 8-6 to affirm two lower court rulings ordering North Carolina and West Virginia to roll back policies that exclude coverage for gender-affirming care. North Carolina’s state health plan does not cover treatment “in connection with sex changes or modifications and related care,” and West Virginia’s Medicaid program covers only some gender-affirming treatments. Attorneys for both states argued in court that the policies were based only on cost concerns, not animus toward transgender
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