Kadel v. North Carolina State Health Plan for Teachers and State Employees, No. 20-1409 (4th Cir. 2021)Annotate this Case
Enrollees in the North Carolina State Health Plan for Teachers and State Employees (NCSHP) sued, alleging that NCSHP discriminates against its transgender enrollees by categorically denying coverage for gender dysphoria treatments like counseling, hormone therapy, and surgical care, in violation of section 1557 of the Patient Protection and Affordable Care Act, which prohibits “any health program or activity” that receives federal funds from discriminating against individuals on any ground prohibited by various federal statutes, including Title IX, 42 U.S.C. 18116(a).
The Fourth Circuit affirmed the denial of NCSHP’s motion to dismiss, asserting that it was entitled to sovereign immunity under the Eleventh Amendment. NCSHP waived its immunity against this claim by accepting federal financial assistance. Under the Civil Rights Remedies Equalization Act (CRREA), “[a] State shall not be immune under the Eleventh Amendment of the Constitution of the United States from suit in Federal court for a violation of . . . any other Federal Statute prohibiting discrimination by recipients of Federal financial assistance,” 42 U.S.C. 2000d-7.