Can West Virginia ban Medicaid coverage for adult gender-affirming surgery? Appeals court to decidehttps://www.advocate.com/health/wv-gender-affirming-surgery-ban 🔗Christopher Wiggins (9 Dec 2025)
"Neither federal statutes nor the Constitution compel states to fund sex reassignment surgeries," a conservative attorney told three judges.
With that opening line, West Virginia's solicitor, Caleb B. David, urged a panel of the U.S. Court of Appeals for the Fourth Circuit to reverse its own ruling and reinstate the state's categorical Medicaid ban on gender-affirming surgery for transgender adults. The case, Anderson v. Crouch, had returned to the court after the U.S. Supreme Court vacated its ruling and remanded it for reconsideration following the high court's 2025 decision in U.S. v. Skrmetti, a case focused narrowly on restrictions for minors.
David argued that West Virginia's exclusion is not about sex or transgender identity at all, but "medical use." Under that notion, he said, heightened constitutional scrutiny never applies.
"[Gender-affirming] surgery isn't covered for any Medicaid beneficiary regardless of sex or transgender status," he told the judges, using an outdated term referring to trans people. "The only relevant question ... is what is the procedure's medical use?"
Judge Julius Richardson asked whether Medicaid recipients can still sue at all.
The judges' questions centered on the Supreme Court's June decision in Medina v. Planned Parenthood South Atlantic, which held that the Medicaid Act's "any qualified provider" provision does not clearly grant patients a private right to sue under federal civil rights law.
In light of that decision, Richardson suggested that the private right of action long assumed in Medicaid litigation may no longer exist... If correct, that threshold issue alone could dispose of the case, no matter how unconstitutional the policy might be.
