Fain v. Crouch

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Status: Open
U.S. District Court for the Southern District of West Virginia
Issues: Health Care Fairness, Transgender Rights

Lambda Legal filed a federal lawsuit challenging West Virginia’s blanket exclusions of coverage for gender-confirming care in its Medicaid and state employee health insurance plans.

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The class-action 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 challenges blanket exclusions of coverage for gender-confirming care in West Virginia’s state health plans. 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 and15,000 state employees.

Christopher Fain studies nonprofit leadership at Marshall University and works at a clothing store in Huntington. He is enrolled in Medicaid, the nation’s largest healthcare provider for low-income individuals, but the program does not cover his testosterone prescription, forcing Mr. Fain to cover the cost of his care out-of-pocket, creating a stressful and inequitable financial burden. The Medicaid plan’s exclusion of coverage for his care has caused Mr. Fain economic hardship and humiliation.

Zachary Martell is married to Brian McNemar, who works as an accountant at a state hospital. Both Mr. Martell and Mr. McNemar rely on the state employee health plan for coverage. Mr. 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.” As a result, Mr. Martell and Mr. McNemar have been forced to pay out-of-pocket for Mr. Martell’s care and, at times, even delay or forego care altogether.

Lambda Legal has filed similar lawsuits against other states that include blanket exclusions for gender-confirming in state employee health plans. In March, Lambda Legal secured a victory for an Alaska state librarian denied coverage for her gender-confirming care. Also, in March, a U.S. district court judge denied an effort by the state of North Carolina to dismiss a lawsuit filed by Lambda Legal on behalf of North Carolina state employees and their dependents denied coverage for gender-confirming care.