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What is gender-affirming care? | Judge rules it must be covered by N.C. employee health plan

A federal judge ruled that the North Carolina state employee health plan must cover gender-affirming care, but what does that mean?

GREENSBORO, N.C. — A federal judge has ruled that the North Carolina state employee healthcare plan cannot exclude gender-affirming care for transgender and non-binary individuals.

The lawsuit, Kadel v. Folwell, was filed in 2019 by eight current or former state employees and their dependents who were denied coverage of gender-affirming care under the North Carolina State Health Plan (NCSHP).

"(This decision) sent a message that everybody is welcome in North Carolina and that everybody should be able to work and receive the same compensation and benefits and that (they) should not be denied because of who they are," said Omar Gonzalez-Pagan, who represented the eight plaintiffs through Lambda Legal.

The judge ruled that the NCSHP violated the Equal Protection Clause of the U.S. Constitution and Title VII of the Civil Rights Act of 1964. 

"After years of fighting for fair treatment, finally having a court decide that these healthcare exclusions are wrong is vindicating. As government employees, all we want is equal access to healthcare, but we were denied just because we are transgender,” said Julia McKeown, one of the plaintiffs, in a statement. 

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What is gender-affirming care?

According to the U.S. Department of Health and Human Services, gender-affirming care can be a wide variety of medical and non-medical services that helps someone's physical traits match their gender identity. 

"When we are talking about gender-affirming medical treatment specifically what we are really talking about is typically hormone therapy or surgery, not all of which is something that patients necessarily need to have or want to have depending on the individual, to define themselves as whatever their gender is," said Dr. Natalie Alexander, a primary care physician with Cone Health. 

Dr. Alexander said she is one of the few primary care physicians in North Carolina that prescribes hormones to patients. However, she said, gender-affirming care does not have to be strictly medical interventions. 

"That could be anything that a person chooses to do to make themselves look or feel a certain way," said Dr. Alexander. 

According to Dr. Alexander, the medical treatment is not overly complicated and she said it's important for these patients to have access. 

"I think I understand the concern and the controversy behind, 'well why should this be considered medical treatment because it’s not necessarily life-saving in the sense that we normally think about it? But a lot of medicine is like that when we get to it," she said. "This is definitely something that I consider life or death in the sense that this is really people's quality of life that we are talking about and I want to do everything I can as a medical professional to help them get to that place."

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