Emily Allen Published

Transgender Medicaid, PEIA Recipients Sue W.Va. DHHR For Discrimination


National advocates for LGBTQ rights are suing West Virginia health leaders, saying state-run plans for insurance are discriminatory toward the transgender West Virginians who rely on them.

A class action lawsuit filed Thursday by Lambda Legal targets West Virginia’s Medicaid program, which serves low-income residents of the state, and the Public Employees Insurance Agency, which offers coverage to state employees and their families.

According to the complaint, all plans offered via Medicaid and PEIA list gender-confirming care as an “exclusion,” or a specific medical service that the plan will not pay for.

Gender-confirming care can include hormonal replacement therapy, surgery and counseling. Access to this kind of care, attorneys write, can reduce the stress and discomfort that transgender people face when the gender they were assigned at birth doesn’t align with their gender identity.

Christopher Fain, one of three West Virginia men listed as plaintiffs in Thursday’s lawsuit, said that for him, gender-confirming care has been life-saving. Fain, a transgender man who uses Medicaid, said he had to pay out of pocket for gender-affirming surgery.

“This care is not optional. This care is essential and medically necessary,” Fain said at a virtual press conference Thursday. “To be denied coverage for care simply because I’m transgender is not only discriminatory, but demoralizing”

Fain spoke Thursday alongside attorneys from Lambda Legal, the Employment Center and Andrew Schneider, executive director of Fairness West Virginia.

“The state of West Virginia shouldn’t single out certain communities to deny health care coverage. But these blanket exclusions do just that,” Schneider said. A survey from Fairness West Virginia released in November found that around 25 percent of transgender West Virginians rely on Medicaid for health care, and roughly 14 percent rely on PEIA.

The same survey reports that 45 percent of transgender West Virginians, not specifying health care coverage, have experienced some discrimination in health care, while 17 percent have been refused care.

Schneider described Fairness West Virginia’s Transgender Health Initiative, which was designed to train doctors and medical providers on transgender health needs.

“We work with doctors whose hands are tied and can’t help their patients access gender affirming care they need because of the exclusions,” Schneider said.

The state Department of Health and Human Resources, which oversees the Bureau for Medical Services and West Virginia Medicaid, said they needed more time Thursday afternoon to look over the lawsuit.

Members from PEIA also said they needed more time to review the lawsuit.

Lambda Legal has filed similar class action lawsuits in other states like Georgia, Arizona and North Carolina. Several cases related to Medicaid are still pending, although the legal team has seen a handful of victories regarding public employee plans in Alaska and Wisconsin.

Emily Allen is a Report for America corps member.