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The North Carolina state employee health plan unlawfully discriminates by excluding treatments for transgender people by refusing to pay for hormone therapy and surgeries, as it once did briefly, a federal judge ruled Friday.

U.S. District Judge Loretta Biggs sided with several transgender people or their parents in declaring the refusal of coverage for treatments linked to gender confirmation violates the equal protection clause of the Constitution and Title VII of the Civil Rights Act on the basis of sex.

Biggs ordered that the State Health Plan resume offering “medically necessary services for the treatment of gender dysphoria,” which the plan’s board of trustees provided in 2017 but did not continue afterward. Monetary damages will be considered in a trial set to begin next month, her order said. Friday’s ruling considered competing motions and experts.

“After years of fighting for fair treatment, finally having a court decide that these healthcare exclusions are wrong is vindicating,” North Carolina State University professor Julia McKeown, one of the plaintiffs in a 2019 lawsuit, said in a news release from Lambda Legal, which provided representation. “As government employees, all we want is equal access to healthcare, but we were denied just because we are transgender.”

The State Health Plan, which is overseen by Treasurer Dale Folwell’s office, provides medical coverage for nearly 750,000 teachers, other employees, retirees and their dependents. Folwell, who took office in early 2017, was sued, along with the health plan, its top executive and other government entities.

While the state’s treasurer office was still reviewing the ruling late Friday, Folwell said in an interview that the board of trustees has had the ability to set benefits for several decades.

Folwell said he had hoped that before Biggs ruled she “would trust the people of North Carolina to have a jury trial on whether taxpayers should be paying for sexual transition operations.” Plan revenue includes state funds and premiums.

Biggs wrote that the plaintiffs’ doctors and experts, medical associations and the plan’s third-party administrators agreed that such treatments “can be medically necessary to treat gender dysphoria in some cases.”

“Defendants’ belief that gender-affirming care is ineffective and unnecessary is simply not supported by the record,” she added.

When agreeing to cover the medically necessary services for 2017, the plan’s board estimated the annual cost for such coverage would be several hundred thousand dollars, according to the order. The U.S. Department of Health and Human Services had finalized in 2016 a regulation prohibiting coverage exclusions related to gender transition. Biggs didn’t rule Friday on whether the plan’s actions violated the 2010 federal health care law, as the plaintiffs alleged.

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