West Virginia Can Ban Medicaid Coverage for Gender-Affirming Surgeries, Court Rules

A U.S. Appeals court has upheld West Virginia’s policy of excluding coverage for gender-affirming surgeries under its Medicaid program. The ruling, issued Tuesday, marks a victory for state officials who argued the procedures are not medically necessary and represent an inappropriate use of taxpayer funds.

Background of the Case

The case, Anderson v. Crouch, originated from a challenge to West Virginia’s decision to deny Medicaid reimbursement for surgical procedures related to gender dysphoria. Plaintiffs argued that the exclusion violated the Equal Protection Clause of the U.S. Constitution, the Affordable Care Act, and the Medicaid Act. A district court initially sided with the plaintiffs, halting enforcement of the policy.

Appeals Court Decision

The Fourth Circuit Court of Appeals reversed the lower court’s ruling, finding that West Virginia’s policy does not violate federal law. The court determined that the state had legitimate reasons for the exclusion, including concerns about cost, medical efficacy, and the safety of the procedures WV MetroNews.

Supreme Court Influence

The case’s path to the Fourth Circuit was influenced by a U.S. Supreme Court decision in United States v. Skrmetti, which affirmed states’ authority to make policy decisions regarding medical interventions. The Supreme Court vacated a previous Fourth Circuit ruling and remanded the case back for reconsideration in light of its decision WV Public.

Reactions to the Ruling

West Virginia Attorney General JB McCuskey hailed the decision as a win for taxpayers. He stated that the state should not be required to fund procedures deemed “unproven” and “non-essential,” arguing that taxpayer dollars should be prioritized for treatments for conditions like cancer, heart disease, and diabetes WV Public.

Governor Patrick Morrisey also expressed satisfaction with the ruling, emphasizing the state’s responsibility to manage public programs responsibly WV MetroNews.

Legislative Action

West Virginia legislators have introduced Senate Bill 921, which seeks to permanently ban Medicaid funding for both gender transition procedures and abortions. The bill would also disqualify providers who offer these services from participating in West Virginia Medicaid WVVA. The bill is scheduled to accept effect on October 1, 2026 WVVA.

Key Provisions of Senate Bill 921

• Ban Medicaid funds for gender transition procedures, including medication and surgery.
• Disqualify providers offering gender-affirming care from Medicaid participation.
• Restrict Medicaid funding for abortions, except in cases of medical necessity as defined by West Virginia law §16-2R-3.
• Bar providers performing or referring for abortions from Medicaid participation.
• Prohibit state funds from being used to provide, promote, or refer for gender transition procedures or abortions.
• Bar state government contracts with entities providing these services.