A federal appeals court has reinstated West Virginia’s ban on Medicaid coverage for adult gender-affirming surgeries, and legal observers say the ripple effects won’t stop at state lines.
The case is Anderson v. Crouch. The 4th U.S. Circuit Court of Appeals reversed a lower court’s ruling in March, putting West Virginia’s prohibition back in place. The lower court had called the ban discriminatory. The three-judge appeals panel didn’t see it that way, and the reasoning it used is what’s got people paying attention far outside the 4th Circuit’s geography.
Here’s the thread that connects it all. In December 2024, the U.S. Supreme Court decided U.S. v. Skrmetti, letting Tennessee enforce its ban on gender-affirming care for minors. That Supreme Court decision vacated a string of lower court rulings and sent several cases back for reconsideration, including the West Virginia matter. The 4th Circuit picked it back up and pushed the Supreme Court’s logic further, applying it not just to youth care but to adult Medicaid coverage. That’s new ground.
The panel’s opinion was unanimous and direct. The judges wrote that “it is not irrational for a legislature to encourage citizens ‘to appreciate their sex’ and not ‘become disdainful of their sex’ by refusing to fund experimental procedures that may have the opposite effect.” Then came the cite. “The panel then cited Skrmetti directly:” writing that “The Supreme Court’s decision in Skrmetti forecloses any argument to the contrary.”
The plaintiffs have asked for a full-circuit rehearing. That process is ongoing.
What the 4th Circuit can’t do, technically, is set binding precedent for states outside its own jurisdiction. That circuit covers Virginia, Maryland, West Virginia, North Carolina, and South Carolina. Michigan sits in the 6th Circuit. So Anderson v. Crouch doesn’t force anything here.
But court precedent and legislative momentum aren’t the same animal.
“This gives states leeway to enact laws that would potentially restrict access to gender-affirming care for trans youth and adults,” said Elana Redfield, federal policy director at the Williams Institute, a UCLA School of Law think tank. “It could encourage states” to move in that direction, she told Michigan Advance.
Redfield’s organization tracks LGBTQ+ policy nationally and has published research linking gender-affirming care, including hormone therapy, surgical procedures, and related treatments, to measurably better mental health outcomes. The American Medical Association has taken similar positions on the clinical evidence.
Right now, Michigan covers gender-affirming care through Medicaid. That coverage comes from a combination of state policy decisions and prior federal guidance, and it’s administered through rules enforced by the Michigan Department of Health and Human Services. It’s not the product of a court order, which means it doesn’t automatically fall if a court ruling shifts the legal landscape. But it also means it’s a policy decision, and policy decisions can change.
That distinction matters. If the 6th Circuit were to follow the 4th Circuit’s reasoning in a future case, Michigan’s Medicaid coverage could face a direct legal challenge. And even without a lawsuit, a ruling like this hands political ammunition to legislators in any state who want to curtail coverage without waiting for a court to force the issue.
The 04/24/2026 Michigan Advance report specifically flagged the national implications of the Anderson v. Crouch decision, noting that Redfield sees the ruling as an invitation for states well outside the 4th Circuit’s reach. What happens in states like Virginia and North Carolina under this ruling can set a template that travels.
Michigan’s current Medicaid policy on gender-affirming care wasn’t handed down from a judge. It came from choices made by state agencies and elected officials. That makes it durable against certain legal attacks. It also makes it exactly the kind of policy a future administration could revisit without going anywhere near a courtroom.
The plaintiffs in Anderson v. Crouch haven’t given up. The request for full-circuit rehearing is the next step, and how the 4th Circuit responds will shape whether this ruling stays as it is or gets pushed further.
