State employee health plan must cover gender-affirming care

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RALEIGH, North Carolina — On Friday, U.S. District Judge Loretta Biggs ruled that North Carolina must cover gender-affirming health care for people with state employee health insurance coverage.

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The lawsuit, Kadel v. Folwell, was filed in 2019 on behalf of several current and former state employees and their dependents

The plaintiffs had the state employee health plan and were denied coverage for their medically necessary gender-affirming care

On Friday, a federal judge ruled that NC must cover gender-affirming health care for people with state health insurance coverage.

North Carolina still has the option to appeal this decision.

The lawsuit, Kadel v. Folwell, was filed in 2019 on behalf of several current and former state employees and their dependents. The plaintiffs had the state employee health plan and were denied coverage for their medically necessary gender-affirming care.

The move means state employees and their dependents will get coverage for health care associated with gender transition, including counseling, hormone therapy, surgery and more.

Due to a non-discrimination rule in the Affordable Care Act, the state health insurance plan covered gender-affirming care in 2017 and possibly even before, but that coverage expired in 2018. .

The ruling found that the state’s exclusion of gender-affirming health care violates the Constitution’s Equal Protection Clause and Title VII of the Civil Rights Act on the basis of sex.

Carl Charles is senior counsel at Lambda Legal, the law firm that represented the plaintiffs, and Charles says this is a landmark decision.

“This is a victory not just for state employees who are transgender or state employees whose dependents are transgender. This is a victory for all supporters of equality and fairness in North Carolina,” Charles said. “It sends a very clear message to all transgender people who live in North Carolina, make a living here, raise families here, that this is a place where transgender people are welcome and where they can count on the same types of health care benefits if they are government employees like any other.

The state health plan is overseen by the office of state treasurer Dale Folwell. Folwell had hoped, before the judge ruled, that there would be a jury trial on whether the taxpayers should pay for “gender reassignment operations.” The scheme’s income includes state funds and premiums.

North Carolina still has the option to appeal this decision. Charles says attorneys are still determining how this ruling applies to the plaintiff’s claims under the Affordable Care Act as well as any potential monetary damages.

Going forward, Charles says lawyers will also work to ensure people get the coverage promised under this ruling.

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