West Virginia
Transgender care polices in W.Va., NC are discriminatory, judge rules
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 people. Judge Roger Gregory, writing for the majority Monday, said the states’ restrictions are “obviously discriminatory.”
“Because we hold that the coverage exclusions facially discriminate on the basis of sex and gender identity, and are not substantially related to an important government interest, we affirm the district courts,” Gregory wrote in the majority opinion. “We further hold that the West Virginia exclusion violates the Medicaid Act and the Affordable Care Act.”
A federal judge in 2022 ruled that North Carolina’s health plan discriminates against transgender people by excluding coverage for gender-affirming medical care. The same year, another court ruled that West Virginia’s Medicaid program must provide coverage for care.
In a statement Monday, Tara Borelli, senior legal counsel at Lambda Legal and the lead attorney on both cases, said the 4th Circuit’s ruling “will save lives.”
“It confirms that discriminating against transgender people by denying critical medical care is not only wrong but unconstitutional,” she said. “No one should be denied essential health care, but our clients in both cases were denied coverage for medically necessary care prescribed by their doctors just because they’re transgender.”
“West Virginia’s denial of medically necessary care just because of who I am was deeply dehumanizing,” said Shauntae Anderson, one of the plaintiffs in the case against the state’s Medicaid program. “I am so relieved that this court ruling puts us one step closer to the day when Medicaid can no longer deny transgender West Virginians access to the essential healthcare that our doctors say is necessary for us.”
Gender-affirming health care for transgender minors and adults is considered medically necessary by major medical organizations, though not every trans person chooses to medically transition or has access to care. Twenty-four states since 2021 have banned treatments for transgender youths, according to the Movement Advancement Project, a nonprofit that tracks LGBTQ laws, and legislation in some states also restricts access to care for adults.
In more than a dozen states, gender-affirming care is explicitly excluded from state employee benefit plans, and Medicaid policies in 10 states exclude coverage for transition-related care for individuals of all ages. In three states, Medicaid can be used to cover the cost of gender-affirming care for transgender adults but not minors.
West Virginia’s Republican attorney general, Patrick Morrisey, responding to the 4th Circuit ruling with a vow to take the case to the Supreme Court.
“Decisions like this one, from a court dominated by Obama- and Biden-appointees, cannot stand: we’ll take this up to the Supreme Court and win,” he said in a statement. Morrisey, who is currently campaigning for governor of West Virginia, last week said he also plans to appeal a separate 4th Circuit ruling blocking the state from enforcing its restrictions on transgender student-athletes to the Supreme Court.
North Carolina State Treasurer Dale Folwell (R), whose office oversees the state’s health plan, said Monday’s 4th Circuit decision was “untethered to the reality” of the fiscal situation of the plan, which is “facing the real risk of looming insolvency.”
“Accordingly, the Plan cannot be everything for everyone — our priority is to provide coverage that does the most good for the highest number of people with the finite resources we have available,” Folwell said in a statement.
“As I have said consistently, I respect the rule of law and, therefore, will continue to follow every legal avenue available to protect the Plan and its members,” he added.
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CHARLESTON, W.Va. — The following events happened on these dates in West Virginia history, compiled by the West Virginia Humanities Council from its online encyclopedia, e-WV.
April 19, 1896: Writer Melville Davisson Post was born in Harrison County. His best-known works are the Randolph Mason series, published in three volumes, and the more successful collection Uncle Abner: Master of Mysteries.
April 19, 1902: Author Jean Lee Latham was born in Buckhannon. She wrote a number of children’s books, including Carry On, Mr. Bowditch, which won the 1956 Newbery Award.
April 20, 1823: Gen. Jesse Lee Reno was born in Wheeling. He graduated from West Point in 1846 with another cadet from western Virginia, Thomas J. Jackson, later known as “Stonewall.” Reno was the highest-ranking officer from present West Virginia killed in the Civil War.
April 20, 1863: President Abraham Lincoln issued a proclamation that in 60 days, West Virginia would become a state. The occasion was marked 100 years later during the state’s Centennial celebration with a special ceremonial session of the West Virginia Legislature on April 20, 1963, in Wheeling.
April 20, 1909: Fiddler Melvin Wine was born near Burnsville in Braxton County. A favorite of old-time music enthusiasts nationally, he was chosen as a National Heritage Fellow in 1991 by the National Endowment for the Arts — the highest recognition given to a folk artist in the United States.
April 20, 1939: Poet Irene McKinney was born in Belington, Barbour County. Gov. Gaston Caperton appointed her state poet laureate in 1993, and she served in that capacity until her death in 2012.
April 21, 1908: Musician Phoeba Cottrell Parsons was born in Calhoun County. Parsons’ traditional clawhammer banjo style, unaccompanied ballad singing, riddles and storytelling have influenced countless younger musicians.
April 21, 1936: President Franklin Roosevelt established the Jefferson National Forest. The West Virginia portion of the forest includes about 19,000 acres in Monroe County.
April 22, 1908: Marshall “Little Sleepy” Glenn was born in Elkins. Glenn coached basketball at West Virginia University from 1934 to 1938 and football from 1937 to 1940. He was inducted into the WVU Sports Hall of Fame in 1992.
April 22, 1948: Grammy-nominated singer-songwriter and musician Larry Groce was born in Dallas, Texas. He is best known as the longtime host and artistic director of the Mountain Stage radio program.
April 22, 2003: Activist Judy Bonds, a Raleigh County native, received the Goldman Environmental Prize for her fight against mountaintop removal mining. Her efforts inspired thousands and turned a local West Virginia issue into a national cause.
April 23, 1857: Andrew S. Rowan was born in Gap Mills, Monroe County. Rowan, a military officer, was chosen as the messenger when President William McKinley wanted to send a message to Cuban Gen. Calixto Garcia during the Spanish-American War. The 1899 pamphlet A Message to Garcia made the incident famous.
April 24, 1865: McNeill’s Rangers surrendered to Union troops at New Creek — now Keyser. The Confederate guerrilla force probably never numbered more than 100 men at any time but managed to inflict regular damage on Union operations.
April 25, 1863: In what became known as the Jones-Imboden Raid, about 1,500 Confederate soldiers under Gen. William “Grumble” Jones advanced through Greenland Gap, a deep pass through New Creek Mountain in present Grant County. The Confederates encountered 87 Union soldiers who held off several assaults before finally surrendering.
April 25, 1923: Union leader Arnold Ray Miller was born at Leewood on Cabin Creek in Kanawha County. In December 1972, he defeated Tony Boyle to become president of the United Mine Workers and served until 1979.
e-WV is a project of the West Virginia Humanities Council. For more information, contact the council at 1310 Kanawha Blvd. E., Charleston, WV 25301, call 304-346-8500 or visit wvencyclopedia.org.
During the Gold-Blue spring game on Saturday, the West Virginia coaching staff named wide receiver Cyrus Traught the recipient of the 2026 Tommy Nikolich Award.
The award, which is always given out at the end of spring ball, recognizes a walk-on team member who has distinguished himself through his attitude and work ethic. The award is presented in memory of Tommy Nickolich, a former WVU player (1980-82) who passed away from cancer in 1983.
Traugh is a Parkersburg native and graduate of Parkersburg South High School. He began his career at Youngstown State before transferring back home to play for the Mountaineers last season. In his final year with the Penguins, he logged 36 receptions, 409 yards, and a team-leading five touchdowns, two of which came against Pitt.
During the 2025 campaign with the Mountaineers, he saw action against Robert Morris and Kansas, playing 10 snaps against the Jayhawks, but did not record any stats.
Head coach Rich Rodriguez has mentioned him twice this spring as someone who has been doing some good things and making progress. Wide receivers coach Ryan Garrett also showed him some love during his press conference last week.
The Mountaineers completely revamped the wide receiver room this offseason, upping the level of talent at both inside and outside receiver spots, but perhaps Traugh can work his way into the mix if he puts together a strong summer and fall camp. If he’s not a regular in the rotation, he’ll serve as a quality depth piece who can play special teams.
Past Nickolich Award winners:
2025: Clay Ash, RB
2024: Avery Wilcox, S
2023: C.J. Cole, WR
2022: Nick Malone, OL
2021: Graeson Malashevich, WR/H
2020: Osman Kamara, S
2019: Jake Abbott, LB
2018: Evan Staley, K
2017: Nick Meadows, LS
2016: Jon Lewis, DL
2015: Justin Arndt, LB
2014: Michael Calicchio, OL
2013: Connor Arlia, WR
2012: Tyler Anderson, DE
2011: Ryan Nehlen, WR
2010: Matt Lindamood, FB
2009: Josh Taylor, DL
2008: Adam Hughes, LS
2007: Andy Emery, LB
2006: Tim Lindsey, LS
2005: George Shehl, H/DB
2004: Jeff Noechel, LB
2003: John Pennington, WR
2002: Moe Fofana, RB
2001: Jeremy Knapp, TE
2000: Ben Collins, LB
1999: Bryan Lorenz, LB
1998: Mark Corman, TE
1997: David Lightcap, DB
1996: Matt Ceresa, OL
1995: Rob Keys, DB
1994: Randy Fulmore, DB
1993: Matt McCulty, WR
1992: Brett Parise, WR, Ray Wilcox, LB
1991: Keith Taparausky, RB
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