WASHINGTON – TheSupreme Courton June 30 said lower courts must reconsider their decisions that government-sponsored insurance plans must pay for gender-affirming care, taking into account the justices' recent landmark rulingupholdingTennessee's ban on gender affirming care for minors. The court also directed a reconsideration of a decision allowing transgender people to challenge Oklahoma's refusal to let them change their gender designation on their birth certificate. All of the cases at least partly turn on the Constitution's guarantee that governments should treat people equally, the same legal issue the court weighed when finding Tennessee's ban did not violate that protection. More:Supreme Court upholds state ban on transgender minors using puberty blockers, hormone therapy But the court's 6-3 decision left unanswered how its ruling might apply to bans on transgender participation in school sports, bans on transgender care for adults, and other issues. The Richmond-based 4th U.S. Circuit Court of Appeals had ruled North Carolina's and West Virginia's refusal to cover certain health care for transgender people is discriminatory. West Virginia's Medicaid program had prohibited "transsexual surgery" because of "concerns like cost and effectiveness." North Carolina's health plan for state employees excluded treatments "leading to or in connection with sex changes or modifications." North Carolina argued that, as part of the difficult choices it has to make to keep health care coverage affordable, it can exclude certain treatments as long as there's no proof of "invidious discrimination." Dozens of state Medicaid and employee health care plans across the country have similar exclusions, according to North Carolina. The appeals court said both states' coverage exclusions discriminate on the basis of sex and gender identity and do not advance an important government interest. The divided panel also said West Virginia's prohibition violated the Medicaid Act and the Affordable Care Act. In a related case, the San Francisco-based 9th U.S. Circuit Court of Appeals said Idaho's head of Medicaid can be sued for not approving sex-reassignment surgery. That decision must now be reconsidered. 'Cruelty over care':Transgender care advocates blast Supreme Court In the Oklahoma case, the Denver-based 10thU.S. Circuit Court of Appeals last yearsaidthree transgender people could challengeOklahoma Gov. Kevin Stitt's banon allowing transgender people to get new birth certificates to match their gender identity. "I believe that people are created by God to be male or female. Period," Stitt, the governor, said in 2021. A federal district judge dismissed the challenge to Stitt's executive order. But the 10thCircuit Court of Appeals overturned that decision last year. A three-judge panel said the policy likely discriminates against transgender people and has no legitimate justification. The court rejected the state's argument that changing birth certificates diminishes the accuracy of birth statistics. Oklahoma retains the original birth certificates so "the same statistics are available, regardless of whether the Policy exists," the court wrote. The original birth certificates can also be used to enforce Oklahoma's ban on transgender athletes competing in women's sports, the court added. This article originally appeared on USA TODAY:Supreme Court tells lower courts to reconsider transgender cases
