Justices Send Trans Coverage Exclusion Case Back to Lower Court

The US Supreme Court on Monday granted review, vacated the underlying decision, and sent back to a federal appeals court a ruling that a public employee health plan’s blanket coverage exclusion for gender dysphoria treatments violated the 14th Amendment equal protection clause.

The US Court of Appeals for the Fourth Circuit’s decision may have been superseded by a recent top court ruling upholding a state’s ban on certain treatments for transgender minors. The petition by North Carolina’s teachers’ health plan officials was one of several at the top court that challenged laws and policies allegedly biased against trans people.

“North Carolina’s exclusion of coverage for sex-change treatments does not draw any classifications based on any protected trait,” North Carolina Treasurer Dale Folwell (R) said in the petition. Instead, it draws a line between diagnoses, he said. A majority of the justices agreed in United States v. Skrmetti that the minors’ care ban differentiated among minors based on the reason for the medical treatment, not the person requesting it.

The North Carolina plan impermissibly discriminated on the basis of sex by excluding payment only when the treatment’s purpose was to align a person’s gender with a gender identity that didn’t match their sex assigned at birth, the plaintiffs said.

Lambda Legal Defense & Education Fund; Advocates for Trans Equality Education Fund; Cooley LLP; Nichols Kaster PLLP; HWG LLP; the Employment Law Center PLLC; and McDermott Will & Emery LLP represent the plaintiffs. Clement & Murphy PLLC and Bell, Davis & Pitt PA represent the North Carolina officials.

The case is Folwell v. Kadel, U.S., No. 24-99, granted, vacated, & remanded 6/30/25.