KADEL v. NC STATE HEALTH PLAN FOR TEACHERS

No. 20-1409.

12 F.4th 422 (2021)

Maxwell KADEL; Jason Fleck; Connor Thonen-Fleck, by his next friends and parents; Julia Mckeown; Michael D. Bunting, Jr.; C.B., by his next friends and parents; Sam Silvaine, Plaintiffs-Appellees, v. NORTH CAROLINA STATE HEALTH PLAN FOR TEACHERS AND STATE EMPLOYEES, Defendant-Appellant, and, Dale FOLWELL, in his official capacity as State Treasurer of North Carolina; University of North Carolina at Chapel Hill; North Carolina State University; Dee Jones, in her official capacity as Executive Administrator of the North Carolina State Health Plan for Teachers and State Employees; University of North Carolina At Greensboro, Defendants. STATE of California; State of Colorado; State of Delaware; State of Hawaii; State of Illinois; State of Maine; Commonwealth of Massachusetts; State of Minnesota; State of Nevada; State of New Jersey; State of New Mexico; State of New York; State of Oregon; State of Rhode Island; State of Vermont; State of Washington; State of Wisconsin; District of Columbia; Equality North Carolina; Clearinghouse on Women's Issues; Feminist Majority Foundation; Gender Equality Law Center; Harvard Law School LGBTQ+Advocacy Clinic; Legal Voice; Naral Prochoice America; National Center for Lesbian Rights; National Health Law Program; National Women's Law Center; North Carolina Aids Action Network; Planned Parenthood South Atlantic; Women's Bar Association of the District of Columbia; Women's Bar Association of the State of New York, Amici Supporting Appellees.

United States Court of Appeals, Fourth Circuit.

Decided: September 1, 2021.


Attorney(s) appearing for the Case

ARGUED: John Guyton Knepper , LAW OFFICE OF JOHN G. KNEPPER, LLC, Cheyenne, Wyoming, for Appellant. Omar Francisco Gonzalez-Pagan , LAMBDA LEGAL DEFENSE & EDUCATION FUND, INC., New York, New York, for Appellees. ON BRIEF: Mark A. Jones , Kevin G. Williams , BELL, DAVIS & PITT, PA, Winston-Salem, North Carolina, for Appellant. Samuel R. Bagenstos , Ann Arbor, Michigan; Tara L. Borelli , Atlanta, Georgia, Carl S. Charles , LAMBDA LEGAL DEFENSE AND EDUCATION FUNC, INC., New York, New York; Amy E. Richardson , Lauren E. Snyder , HARRIS, WILTSHIRE & GRANNIS LLP, Washington, D.C.; David P. Brown , TRANSGENDER LEGAL DEFENSE & EDUCATION FUND, INC., New York, New York, for Appellees. Xavier Becerra , Attorney General, Renu R. George , Senior Assistant Attorney General, Kathleen Boergers , Supervising Deputy Attorney General, Nicole Ries Fox , Deputy Attorney General, OFFICE OF THE ATTORNEY GENERAL OF CALIFORNIA, San Diego, California, for Amicus State of California. Philip J. Weiser , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF COLORADO, Denver, Colorado, for Amicus State of Colorado. Kathleen Jennings , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF DELAWARE, Wilmington, Delaware, for Amicus State of Delaware. Clare E. Connors , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF HAWAII, Honolulu, Hawaii, for Amicus State of Hawaii. Kwame Raoul , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF ILLINOIS, Chicago, Illinois, for Amicus State of Illinois. Aaron M. Frey , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF MAINE, Augusta, Maine, for Amicus State of Maine. Maura Healy , Attorney General, OFFICE OF THE ATTORNEY GENERAL FOR THE COMMONWEALTH OF MASSACHUSETTS, Boston, Massachusetts, for Amicus Commonwealth of Massachusetts. Keith Ellison , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF MINNESOTA, St. Paul, Minnesota, for Amicus State of Minnesota. Aaron D. Ford , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF NEVADA, Carson City, Nevada, for Amicus State of Nevada. Gurbir S. Grewal , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF NEW JERSEY, Trenton, New Jersey, for Amicus State of New Jersey. Hector Balderas , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF NEW MEXICO, Santa Fe, New Mexico, for Amicus State of New Mexico. Letitia James , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF NEW YORK, New York, New York, for Amicus State of New York. Ellen F. Rosenblum , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF OREGON, Salem, Oregon, for Amicus State of Oregon. Peter F. Neronha , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF RHODE ISLAND, Providence, Rhode Island, for Amicus State of Rhode Island. Thomas J. Donovan, Jr. , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF VERMONT, Montpelier, Vermont, for Amicus State of Vermont. Robert W. Ferguson , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF WASHINGTON, Olympia, Washington, for Amicus State of Washington. Joshua L. Kaul , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF WISCONSIN, Madison, Wisconsin, for Amicus State of Wisconsin. Karl A. Racine , Attorney General, OFFICE OF THE ATTORNEY GENERAL FOR THE DISTRICT OF COLUMBIA, Washington, D.C., for Amicus District of Columbia. Ames Simmons , EQUALITY NORTH CAROLINA, Raleigh, North Carolina; Michael W. Weaver , Chicago, Illinois, Michael S. Stanek , Sarah P. Hogarth , Gilbert T. Smolenski , McDERMOTT WILL & EMERY LLP, Washington, D.C., for Amicus Equality North Carolina. Kevin Barry , QUINNIPIAC UNIVERSITY SCHOOL OF LAW LEGAL CLINIC, Hamden, Connecticut; Kevin Costello , Maryanne Tomazic , Center for Health Law & Policy Innovation, HARVARD LAW SCHOOL, Cambridge, Massachusetts, for Amici Nonprofit Civil Rights, Advocacy, and Public Interest Organizations.

Affirmed by published opinion. Chief Judge Gregory wrote the opinion, in which Judge Diaz concurred in part. Judge Diaz wrote a concurring opinion and Judge Agee wrote a dissenting opinion.


In March 2019, several enrollees in the North Carolina State Health Plan for Teachers and State Employees (NCSHP) filed a three-count complaint against the State Health Plan and other State defendants. Plaintiffs allege that NCSHP discriminates against its transgender enrollees by categorically denying coverage for gender dysphoria...

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