U.S. court allows state bans on gender-affirming care for adults in unprecedented rulinghttps://www.advocate.com/news/court-bans-adult-genderaffirming-care 🔗Desiree Guerrero (11 March 2026)
On Tuesday, the U.S. 4th Circuit Court of Appeals went a step further in the ongoing attacks on gender-affirming care for transgender individuals in this country.
While more than a dozen U.S. states currently prohibit or limit Medicaid coverage for gender-affirming care, the 4th Circuit became the first federal appeals court to enforce this type of law, according to a report by Reuters.
The unanimous decision came from a three-judge panel of the 4th U.S. Circuit Court of Appeals in Richmond, Virginia, overturning a prior judge's ruling in 2024 that the statute violated anti-discrimination protections under federal law as well as the Constitution. In defense of the first-of-its-kind ruling, the 4th Circuit panel stated that since the law applies to specific procedures, not specific individuals, it does not illegally discriminate against transgender people.
"It is not irrational for a legislature to encourage citizens to appreciate their sex and not become disdainful of their sex by refusing to fund experimental procedures that may have the opposite effect," wrote Judge Julius Richardson, a Trump appointee.
The specific types of surgeries that the West Virginia law seeks to remove from Medicaid coverage include altering physical characteristics in order to align with one's gender identity, including chest reconstruction, genital alteration, and facial procedures.
Republican West Virginia Attorney General John McCuskey added that the state should not have to foot the bill for "unproven, non-essential medical procedures."
"Every dollar spent on these unproven procedures takes away funding that could be used to treat cancer, heart disease, and diabetes," stated McCuskey.
