On April 29, 2024, a federal appeals court ruled that the policies in West Virginia and North Carolina, which refused to cover gender-affirming care for transgender individuals under government-sponsored insurance, are discriminatory. This decision was made by the Richmond-based 4th U.S. Circuit Court of Appeals with an 8-6 vote. The court stated that the exclusions discriminate based on sex and gender identity without substantial governmental justification. This legal challenge was brought forth by a plaintiff, Shauntae Anderson, a Black transgender woman from West Virginia. The states involved have expressed intentions to appeal the decision, which might elevate the issue to the U.S. Supreme Court due to conflicting lower court rulings on similar cases.

In a separate event in Florida, Governor Ron DeSantis’s administration has been implementing measures that have resulted in more than 22,500 lower-income children losing their healthcare coverage since January 2024, challenging a new federal “continuous eligibility” rule. This rule is part of the 2023 Consolidated Appropriations Act that mandates 12 months of ensured coverage following at least one premium payment. Representatives from the Florida Health Justice Project emphasize the consequence of these actions, specifying a disenrollment of over 5,000 children in April alone. Criticism has been directed towards these measures by Democratic congresswoman Kathy Castor, who highlighted the negative impacts on families with critically ill children. Despite legal challenges and public outcry, Florida’s healthcare agency maintains that these steps are necessary for the sustainability of the state’s healthcare program.