Appeals Court: Medicaid Program Must Cover Gender-Affirming Care

The Fourth U.S. Circuit Court of Appeals in Richmond, Virginia, upheld a lower court ruling Monday on a vote of 8 to 6 that the state’s Medicaid exclusion violated federal law.

A federal appeals court has ruled that West Virginia’s Medicaid program must cover gender-affirming surgeries.

The Fourth U.S. Circuit Court of Appeals in Richmond, Virginia, upheld a lower court ruling Monday on a vote of 8 to 6 that the state’s Medicaid exclusion violated federal law.

The Fourth Circuit ruling also applies to North Carolina’s health insurance program for state employees.

The states had argued that cost, rather than bias against transgender beneficiaries, was behind excluding gender-affirming surgeries. West Virginia’s Medicaid program does cover hormone therapy, office visits, counseling and lab work.

The court’s majority found that the states’ exclusion did not apply to the same procedures, such as mastectomies or breast reductions, for patients with cancer or excess breast tissue who are not transgender.

Attorney General Patrick Morrisey, a candidate for governor in the state’s Republican primary, said he’d appeal the case to the U.S. Supreme Court.

“Our state should have the ability to determine how to spend our resources to care for the vital medical needs of our citizens,” Morrisey said in a statement.

The West Virginia lawsuit, filed in 2020 in the U.S. District Court for the Southern District of West Virginia, named the former Department of Health and Human Resources and its former secretary, Bill Crouch, as defendants.

The suit also covered PEIA, the state employees’ health insurance program.

District Judge Robert Chambers ruled against the exclusions in 2022. Morrisey appealed to the Fourth Circuit.

Federal Court Rejects State Transgender Student Athlete Ban

The ACLU and Lambda Legal, a national LGBTQ rights law firm, brought the case on behalf of a 13-year-old middle school student in Harrison County who wanted to run on her track team.

A federal appeals court struck down West Virginia’s ban on transgender student participation in school sports Tuesday.

The Fourth U.S. Circuit Court of Appeals in Richmond, Virginia, said the 2021 law violated Title IX, the landmark 1972 law that enshrined gender equality in school sports.

The ACLU and Lambda Legal, a national LGBTQ rights law firm, brought the case on behalf of a 13-year-old middle school student in Harrison County who wanted to run on her track team.

“The ruling makes clear that the law is discriminatory,” said Billy Wolfe, an ACLU-WV spokesman, in an email. The student, Becky Pepper-Jackson, is the only one affected by the ruling, Wolfe said, but encouraged others who might be affected to contact the ACLU.

The 2-1 decision, for now, invalidates House Bill 3293, which the legislature enacted and Gov. Jim Justice signed. 

Last year, a U.S. district judge upheld the enforcement of the law, but the Fourth Circuit overruled that decision.

In an emergency appeal last year, West Virginia Attorney General Patrick Morrisey asked the U.S. Supreme Court to allow the state to enforce the law while the Fourth Circuit considered the case. The justices declined.

In a statement Tuesday, Morrisey said he would continue to defend the law.

West Virginia is one of 21 states that have enacted some type of restriction on transgender student participation in school sports.

In 2020, the Fourth Circuit ruled in favor of a Virginia transgender boy who challenged his school’s refusal to let him use the bathroom that matched his gender identity.

The U.S. Supreme Court declined to hear the appeal in that case as well.

In Tuesday’s ruling, one of the three judges, G. Steven Agee, dissented. He was nominated by President George W. Bush to the court in 2008.

Morrisey Argues In Favor Of Trans Sports Ban To Fourth Circuit

On Friday, West Virginia Attorney General Patrick Morrisey continued to defend the state’s law barring transgender athletes from participating on sports teams that align with their gender identity.

West Virginia Attorney General Patrick Morrisey presented arguments Friday to the Fourth U.S. Circuit Court of Appeals in Richmond, Virginia in a case challenging West Virginia’s law barring transgender athletes from participating on sports teams that align with their gender identity.

In 2021, the West Virginia Legislature enacted a law “to defend the integrity of women’s sports” that prohibits transgender girls and women in the state from competing on sports teams at “any public secondary school or state institution of higher education.”

The bill was signed into law by Gov. Jim Justice on April 28, 2021. 

The American Civil Liberties Union, the ACLU of West Virginia, Lambda Legal, and Cooley LLP challenged the law on May 8, 2021, on behalf of Becky Pepper Jackson, a now 13-year-old middle school transgender girl who would be kicked off her middle school’s girls’ cross country and track and field teams if the law were enforced.

Since then, Morrisey’s office has fought to dismiss the lawsuit.

Morrisey was assisted by attorneys from Alliance Defending Freedom (ADF), a Christian conservative legal organization, in filing this litigation.

In January, a federal judge in the U.S. District Court for the Southern District of West Virginia upheld the law, ruling that the state legislature’s definition of “girl” and “woman” in the context of HB 3293, the “Save Women’s Sports Act,” is “constitutionally permissible” and that the law complies with Title IX.

Title IX was signed into law on June 23, 1972. It prohibits sex-based discrimination in any school or any other education program that receives funding from the federal government.

Morrisey said the law protects female athletes’ safety and keeps female sports competitive for female athletes, consistent with Title IX and the Constitution. 

Jackson’s legal team won a ruling from the lower court blocking enforcement of the law pending final resolution of the case. In February 2023, the U.S. Court of Appeals and the Fourth Circuit blocked the state’s effort to kick Jackson off the team as her legal team appealed the lower court’s subsequent ruling upholding the 2021 law.

In August of this year, the Fourth Circuit reinstated a preliminary injunction that allowed Jackson to continue participating on girls’ sports teams until it rules on her appeal.

The Attorney General’s Office contends that Title IX doesn’t mention transgender status. Instead, the marker is biological sex, which recognizes that there are distinct differences between males and females. Further, Title IX prohibits discrimination on the basis of biological sex, not gender identity.

“Look, I’m very hopeful that we’re going to prevail on the Fourth Circuit,” Morrisey said in a recorded statement. “I think we’re absolutely correct on the law. The district court got it right. And to us, it’s a matter of basic fairness and common sense that biological males should not be playing sports with women. We submitted 3,000 pages; 500 docket entries. This should be so straightforward. I’m hopeful the Fourth Circuit sees our way after these arguments.”

West Virginia is one of 23 states that have banned transgender girls from playing on girls’ teams in the last three years.

Mountain Valley Pipeline Cost Rises To $7.2 Billion, Completion Delayed

In a filing Wednesday, Equitrans Midstream cited labor conditions as part of the reason the project won’t be completed this year and above the $6.6 billion it previously estimated.

The cost of a controversial natural gas pipeline has gone up and its completion delayed.

The 303-mile Mountain Valley Pipeline will now cost $7.2 billion to finish, and that won’t happen until next year, its builders told the U.S. Securities and Exchange Commission.

In a filing Wednesday, Equitrans Midstream cited labor conditions as part of the reason the project won’t be completed this year and above the $6.6 billion it previously estimated.

Construction resumed on the Mountain Valley Pipeline over the summer after Congress required its completion.

It had been held up in court numerous times as environmental groups and landowners successfully challenged the project’s federal permits.

The Fourth U.S. Circuit Court of Appeals dismissed the remaining cases after lawmakers approved those permits.

Appeals Court In Virginia Dismisses Mountain Valley Pipeline Lawsuits

The move follows a ruling last month by the U.S. Supreme Court to allow construction to resume on the project.

A federal appeals court in Richmond, Virginia, has dismissed two lawsuits over a controversial natural gas pipeline.

The Fourth U.S. Circuit Court of Appeals dismissed challenges to two construction permits for the 300-mile Mountain Valley Pipeline.

The move follows a ruling last month by the U.S. Supreme Court to allow construction to resume on the $6.6 billion project.

The pipeline’s opponents, including landowners and environmental groups, challenged permits issued by the U.S. Forest Service and the U.S. Fish and Wildlife Service.

The pipeline’s path crosses a section of the George Washington National Forest as well as the habitat of the candy darter, an endangered fish.

Opponents argue that the pipeline could compromise water quality, cause erosion and leak methane. Supporters say it’s vital to U.S. energy security.

As part of the Fiscal Responsibility Act, which Congress passed in June, lawmakers required the completion of the Mountain Valley Pipeline.

The law also moved jurisdiction over future lawsuits against the pipeline from the Fourth Circuit to the D.C. Circuit.

Appeals Court Again Allows Transgender Student To Participate In Sports

The Fourth U.S. Circuit Court of Appeals in Richmond, Virginia, has denied a bid by West Virginia Attorney General Patrick Morrisey to allow the state to enforce a ban on transgender student participation in school sports.

A transgender student in Harrison County can continue to participate on her school’s track team, a federal court has ruled.

The Fourth U.S. Circuit Court of Appeals in Richmond, Virginia, has denied a bid by West Virginia Attorney General Patrick Morrisey to allow the state to enforce a ban on transgender student participation in school sports.

Lawmakers passed, and Gov. Jim Justice signed, HB 3293 in 2021. The student, Becky Pepper Jackson, challenged the law, represented by the ACLU of West Virginia and Lambda Legal.

A U.S. district judge in Charleston upheld the law in January. Pepper Jackson appealed to the Fourth Circuit, which allowed her to continue her participation on the track team.

On Friday, the Fourth Circuit rejected Morrisey’s assertion that Pepper Jackson’s improvement in discus and shotput was unfair to her teammates and she should be ineligible to participate.

Judge Steven Agee, an appointee of former President George W. Bush, dissented.

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