AG James Protects Access To Gender-Affirming Care From Harlem To Hollis

New York Attorney General Letitia James today continued her work to stand up for transgender rights.

Leading a coalition of 16 attorneys general in filing an amicus brief in the case of Fain v. Crouch supporting efforts to promote equal access to healthcare in West Virginia. The plaintiffs, two transgender individuals, are unable to obtain Medicaid coverage for gender-affirming surgical care by the West Virginia State Medicaid Program.

“Gender-affirming treatment allows trans people to lead healthy and happy lives that are true to themselves,” said Attorney General James. “Denying access to this crucial healthcare and refusing to acknowledge the needs of transgender individuals is discrimination against some of our society’s most vulnerable members. Government policies and resources should help advance equality and serve the needs of everyone, not purposely exclude people because of who they are. I will continue to fight efforts that discriminate against and deny people’s true identities.” 

The brief — filed in the United States Court of Appeals for the Fourth Circuit — argues for the court to affirm a lower court ruling which determined that the West Virginia State Medicaid Program’s denial of medically necessary, gender-affirming surgical care violates the Equal Protection Clause of the Fourteenth Amendment to the U.S. Constitution. The coalition of attorneys general notes that it has been shown through Supreme Court rulings and other cases that discrimination against transgender people violates the Equal Protection Clause because it constitutes discrimination based on sex. The amicus brief also shows that the exclusion does not save governmental insurance programs significant amounts of money and that it is not justified by protecting the public from an ineffective medical treatment. The attorneys general assert that their experience shows gender-affirming treatment improves well-being at a minimal cost.

The brief also notes the efforts that states joining the filing have made to protect transgender healthcare rights and the benefits of these policies. New York law prohibits healthcare discrimination on the basis of transgender identity and, in 2021, all insurance carriers were found to cover gender-affirming care. Many of the other joining states have also adopted policies ensuring access to gender-affirming care for their residents. The brief notes that these policies have categorically improved the well-being of trans people, reducing the risk of suicide, substance abuse, and depression, while not meaningfully increasing premium costs.


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Attorney General James has repeatedly fought for the rights of transgender individuals. In August 2022, Attorney General James co-led a coalition of 22 attorneys general in challenging an Indiana School District’s policy to prohibit transgender students from using bathrooms which corresponded with their gender identity, and in November 2021 co-led a coalition of 23 attorney’s general challenging the same policy in a Florida school district. In October 2021, Attorney General James led a multi-state coalition of attorneys general to support transgender students seeking to participate in sex-segregated school sports consistent with their gender identity. In November 2019, Attorney General James successfully co-led a coalition of attorneys general in the fight to support the rights of transgender students to use bathrooms in line with their gender identity in the case Gavin Grimm v. Gloucester County School Board in the U.S. Court of Appeals for the Fourth Circuit.

Joining Attorney General James in filing the brief are the attorneys general of Joining Attorney General James in filing the brief are the attorneys general of Colorado, Delaware, Illinois, Maine, Maryland, Massachusetts, Minnesota, Nevada, New Jersey, New Mexico, New York, Oregon, Rhode Island, Vermont, Washington, and the District of Columbia.

The amicus brief was prepared by Assistant Solicitor General Daniel S. Magy, Deputy Solicitor General Ester Murdukhayeva, and Solicitor General Barbara D. Underwood — all of the Division of Appeals and Opinions.

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