CHARLESTON, W.Va. — A class-action federal lawsuit was filed Thursday challenging ‘discriminatory’ health care policies in West Virginia.
The lawsuit was filed in the U.S. District Court for the Southern District of West Virginia on behalf of Christopher Fain, a Medicaid participant; and Zachary Martell and Brian McNemar, a dependent and state employee, respectively. The suit was filed by Lambda Legal, Nichols Kaster, PLLP, and the Employment Law Center, PLLC to challenge the ban on transgender health care coverage.
“Transgender and nonbinary West Virginians are denied coverage for essential, and sometimes life-saving, gender-confirming care, while cisgender West Virginians receive coverage for the same kinds of care as a matter of course,” said Avatara Smith-Carrington in a release, a Tyron Garner Memorial Fellow at Lambda Legal and lead attorney on the case.
“The exclusions of gender-confirming care in West Virginia’s state health plans are unconstitutional and discriminatory, and deny transgender and nonbinary West Virginians basic dignity, equality, and respect.”
The lawsuit, Fain v. Crouch, is a class action lawsuit challenging blanket exclusions of coverage for gender-confirming care in West Virginia’s state health plans, a release said. The blanket exclusions of coverage for care are stated expressly in the health plans offered to Medicaid participants and to state employees.
West Virginia’s state health plans serve approximately 564,000 Medicaid participants and 15,000 state employees.
Andrew Schneider, the executive director of Fairness West Virginia said during the virtual press conference Thursday that 40% of transgender people in the state are on Medicaid or state-run PEIA.
“This care can be live-saving. It’s time to ditch the exclusions and have state health plans that provide coverage free from discrimination,” Schneider said during the announcement.
Christopher Fain, who studies nonprofit leadership at Marshall University and works at a clothing store in Huntington, spoke Thursday. He is enrolled in Medicaid, the nation’s largest healthcare provider for low-income individuals, but the program does not cover his testosterone prescription, according to Lambda Legal. The firm said that forces Fain to cover the cost of his care out-of-pocket.
Lambda Legal said the Medicaid plan’s exclusion of coverage for his care has caused Fain economic hardship and humiliation.
“No one should have the door slammed on them while they’re just trying to access basic healthcare,” Fain, 44, said in a release.
“But that’s what these discriminatory exclusions do to people just because they’re transgender. This health care is about my very survival, and the health and survival of thousands of other transgender people in our community forced to go without care because of these exclusions. We feel like we are being swept under the rug, treated as if we don’t exist, and that is not okay.”
Zachary Martell, another person named in the suit is married to Brian McNemar, who works as an accountant at a state hospital. Both Martell and McNemar rely on the state employee health plan for coverage. Martell, who receives coverage for care as Mr. McNemar’s dependent, has been denied coverage both for his prescriptions and office visits with his healthcare provider because the state employee health plans explicitly exclude coverage of “treatments associated with gender dysphoria,” according to the legal tea. Martell and McNemar are then forced to pay out-of-pocket As a result, Mr. Martell and Mr. McNemar have been forced to pay out-of-pocket for Martell’s care.
Lambda Legal has filed similar lawsuits against other states that include blanket exclusions for gender-confirming in state employee health plans including Alaska and North Carolina.
Smith-Carrington, Tara Borelli, Sasha Buchert, and Nora Huppert are handling the matter for Lambda Legal. They are joined by Anna Prakash and Nicole Schladt of Nichols Kaster PLLP; and Walt Auvil of the Employment Law Center, PLLC.