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A federal appeals court is considering cases out of North Carolina and West Virginia that could have significant implications on whether individual states are required to cover health care for transgender people with government-sponsored insurance. The Richmond-based 4th U.S. Circuit Court of Appeals heard oral arguments in cases Thursday involving the coverage of gender-affirming care by North Carolina’s state employee health plan and the coverage of gender-affirming surgery by West Virginia Medicaid. (Willingham, 9/21)

A federal appeals court on Thursday appeared torn on whether state health insurance plans must cover surgeries and other treatments as part of gender transition, in a pair of appeals by North Carolina and West Virginia. The full Virginia-based 4th U.S. Circuit Court of Appeals did not clearly indicate at oral arguments how it would rule in either case, as judges peppered both sides with questions. Of the 14 judges now on the court, eight were appointed by Democratic presidents, and six by Republicans. (Pierson, 9/21)

As Republican-led states have rushed to ban gender-affirming for minors, some families with transgender children found a bit of solace: At least they lived in states that would allow those already receiving puberty blockers or hormone therapy to continue. But in some places, including Missouri and North Dakota, the care has abruptly been halted because medical providers are wary of harsh liability provisions in those same laws — one of multiple reasons that advocates say care has become harder to access even where it remains legal. (Salter and Mulvihill, 9/22)