WINSTON-SALEM, N.C. (AP) — A federal judge has ordered the North Carolina state employee health plan provide “medically necessary services” for transgender people linked to gender confirmation.

U.S. District Judge Loretta Biggs ruled Friday it was unlawfully biased for the State Health Plan to exclude coverage for such treatments.

“I am thrilled beyond measure for this powerful victory not only for myself but other transgender employees across the state,” said North Carolina State University Assistant Professor Julia McKeown. “This decision sends a message of validation to the entire transgender community in North Carolina. After years of fighting for fair treatment, finally having a court decide that these healthcare exclusions are wrong is vindicating. As government employees, all we want is equal access to healthcare, but we were denied just because we are transgender.”

The plan had offered such coverage in 2017 but stopped doing so afterward.

The lawsuit was filed by Lambda Legal and the Transgender Legal Defense & Education Fund in 2019 on behalf of current and former state employees and their dependents.

The judge ruled that the North Carolina State Health Plan and North Carolina state employers violated the Equal Protection Clause of the U.S. Constitution and Title VII of the Civil Rights Act of 1964, by unlawfully discriminating based on sex and transgender status.

Monetary damages could be decided after a trial next month.

The office of State Treasurer Dale Folwell oversees the plan.

Folwell said he believe the case warranted a jury trial on whether taxpayers should pay for such surgeries.


In lawsuit filed by Lambda Legal and TLDEF, U.S. District Court finds that the North Carolina state health plan’s categorical exclusion of medically necessary gender-affirming health care is discriminatory and unlawful

WINSTON-SALEM, NC — Today, a federal judge ruled in favor of plaintiffs in a lawsuit brought by counsel Lambda Legal and Transgender Legal Defense & Education Fund (TLDEF) challenging North Carolina’s categorical exclusion of gender-affirming health care for transgender state employee health plan participants.

Lambda Legal and TLDEF filed the lawsuit, Kadel v. Folwell, in 2019 on behalf of several current and former state employees and their dependents after the North Carolina State Health Plan (NCSHP), the state employee health plan, denied coverage for their medically necessary gender-affirming care.

The trial judge ruled that the NCSHP and North Carolina state employers violated the Equal Protection Clause of the U.S. Constitution and Title VII of the Civil Rights Act of 1964, by unlawfully discriminating based on sex and transgender status. The Court reserved a ruling on the issue of plaintiffs’ claims under the health care nondiscrimination law, known as Section 1557 of the Affordable Care Act, pending rulemaking by the U.S. Department of Health and Human Services under the Biden Administration. Today’s decision comes just five months after the U.S. Supreme Court denied the State of North Carolina’s petition seeking review of a lower court ruling that the NCSHP, a state entity accepting federal financial assistance, was not entitled to sovereign immunity and can be sued if its actions violate the nondiscrimination provisions Section 1557 of the Affordable Care Act.

Tara Borelli, Omar Gonzalez-Pagan, and Carl Charles are the attorneys handling this case for Lambda Legal with David Brown and Ezra Cukor from the Transgender Legal Defense and Education Fund (TLDEF), and Amy E. Richardson, Lauren Snyder, Deepika Ravi, and Grace Wynn of Harris Wiltshire & Grannis LLP, and Michael Weaver, Dmitriy Tishyevich, Warren Haskel, Lauren Evans, and Adam Safer from McDermott, Will & Emery LLP.