US Court Clears State Medicaid Ban On Transgender Surgeries For Adults

West Virginia’s ban on Medicaid coverage of surgical procedures for people with gender dysphoria is legal, a federal court ruled on March 10.

A 2025 U.S. Supreme Court decision means the ban does not violate the U.S. Constitution’s Equal Protection Clause or the Affordable Care Act, U.S. Circuit Judge Julius Richardson, writing for a unanimous panel of judges on the U.S. Court of Appeals for the 4th Circuit, said in a 35-page decision.

West Virginia’s Medicaid plan excludes a number of treatments and procedures, including “infertility services” and “sex changes.”

People who sued over the ban said they were being discriminated against, in part because of the Equal Protection Clause, which says that states must not deny people equal protection under the law.

“To prevail on the equal protection claim, Plaintiffs must first show that the challenged Exclusion discriminates because of sex or transgender status. But they fail to make this showing,” Richardson said.

That’s because the exclusion is based on medical diagnosis, he said.

“West Virginia’s plan does not single out people of a particular sex or transgender status. Rather, the State determines which diagnoses qualify based on the risks it is willing to cover,” the judge said. “Here, West Virginia chose to cover alterations of a person’s breasts or genitalia only if the person experiences physical injury, disease, or congenital absence of genitalia.”

Medicaid is a health insurance program for low-income people run by the U.S. and state governments. About half of U.S. states ban or limit Medicaid coverage for transgender procedures. A number of lawsuits have been filed over the restrictions.

The new decision cited a 2025 ruling from the U.S. Supreme Court that upheld a Tennessee law barring transgender procedures and drugs for minors.

A federal judge ruled against the West Virginia ban in 2022, and the full 4th Circuit struck down the law in 2024.

In 2025, Supreme Court justices told the appeals court to reconsider the prohibition in light of its ruling on the Tennessee statute.

West Virginia officials also offered legitimate reasons for the policy, including concerns about the medical necessity of transgender surgeries, the appeals court panel ruled.

“This is a big win for West Virginia taxpayers who pay the bill for Medicaid—a much needed and utilized program,“ West Virginia Attorney General JB McCuskey said in a statement. ”As good stewards of taxpayer dollars, the state should not be footing the bill for unproven, non-essential medical procedures.”

Lambda Legal, which is representing plaintiffs in the case, did not return a request for comment by the time of publication.