"With that opening line, West Virginia's solicitor, Caleb B. David, urged a panel of the U.S. Court of Appeals for the Fourth Circuit to reverse its own ruling and reinstate the state's categorical Medicaid ban on gender-affirming surgery for transgender adults. The case, Anderson v. Crouch, had returned to the court after the U.S. Supreme Court vacated its ruling and remanded it for reconsideration following the high court's 2025 decision in U.S. v. Skrmetti, a case focused narrowly on restrictions for minors."
"David argued that West Virginia's exclusion is not about sex or transgender identity at all, but 'medical use.' Under that notion, he said, heightened constitutional scrutiny never applies. '[Gender-affirming] surgery isn't covered for any Medicaid beneficiary regardless of sex or transgender status,' he told the judges, using an outdated term referring to trans people. 'The only relevant question ... is what is the procedure's medical use?'"
A three-judge panel of the U.S. Court of Appeals for the Fourth Circuit heard arguments on West Virginia's categorical Medicaid ban on gender-affirming surgery for transgender adults. West Virginia solicitor Caleb B. David urged reversal after the U.S. Supreme Court vacated and remanded the case following the 2025 decision in U.S. v. Skrmetti. David asserted the exclusion concerns medical use and funding rather than sex or transgender status and therefore does not trigger heightened constitutional scrutiny. Judges probed Medicaid's requirement for "reasonable standards" and the limits of state discretion. David emphasized legislative authority and cited safety, efficacy, and cost concerns.
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