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A federal appeals court on Monday ruled that West Virginia and North Carolina’s denial of coverage for certain health care services to transgender individuals with government-sponsored insurance is discriminatory. According to WCCB, the 4th U.S. Circuit Court of Appeals, based in Richmond, voted 8-6 in the case concerning North Carolina’s state employee health plan’s coverage of gender-affirming care and West Virginia Medicaid’s coverage of gender-affirming surgery. The ruling is anticipated to be appealed to the U.S. Supreme Court.

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