AMICUS: Fain v. Crouch, Fourth Circuit

Executive Summary

Medicaid beneficiaries challenged a West Virginia policy excluding coverage of gender-affirming surgery. The district court granted summary judgment for the plaintiffs, and the State appealed. NHeLP and the Center for Medicare Advocacy filed an amicus brief in support of the plaintiffs. The brief argues that approval of West Virginia’s state Medicaid plan is not entitled to deference, coverage of gender-affirming surgery is not optional, and no inferences about CMS’s opinions on Medicaid coverage of gender-affirming surgery can be drawn from its decision not to issue a national coverage policy for Medicare beneficiaries.

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