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PFLAG National Sues North Carolina for Medically Necessary Care

October 11, 2023

Raleigh, N.C. — Today, on National Coming Out Day, PFLAG National, GLMA, and transgender North Carolinians, represented by Lambda Legal and the National Health Law Program (NHeLP), sued the State of North Carolina to block implementation of a discriminatory law banning the provision of medically necessary care for transgender North Carolina youth. The legal advocates simultaneously filed a motion for preliminary injunction seeking to block enforcement of the ban as the court challenge proceeds.

Lambda Legal and NHeLP, alongside private law firms HWG LLP and McDermott Will & Emery LLP, filed the lawsuit, Voe v. Mansfield, on behalf of the family of a transgender adolescent, who seek to proceed pseudonymously under the names of Victor, Vanessa and Vance Voe; North Carolina family physician Dr. Riley Smith, and two national membership organizations with members in North Carolina, PFLAG National and GLMA.

“Everyone in North Carolina should be free to be themselves, on National Coming Out Day and every day. Yet, because of an unjust law, adolescents who are transgender are excluded, and parents lose resources to help their kids thrive,” said Brian K. Bond, CEO of plaintiff PFLAG National. “PFLAG National is suing North Carolina, in addition to Texas and Missouri, so families and transgender individuals can be free to live authentically every day, everywhere.”

The lawsuit challenges North Carolina’s “Act to Prohibit Gender Transition Procedures For Minors” (“HB 808”), which took effect August 16, 2023 immediately upon the legislature’s override of the governor’s veto. HB 808 prohibits medical professionals from providing gender-affirming medical care to transgender adolescents diagnosed with gender dysphoria. Transgender adolescents who were already receiving necessary and appropriate care as of August 1 are allowed to continue with their course of treatment.

“This law will inflict harm on North Carolinian families by denying transgender youth critically-necessary medical treatment that has been proven effective and safe,” Lambda Legal Senior Counsel Tara Borelli (she/hers) said. “Reflecting on National Coming Out Day, this lawsuit fights for the ability of every adolescent to feel cared for and safe. This ban puts LGBTQ youth at risk and creates an unsafe environment for them.”

The complaint says that Victor Voe, the adolescent plaintiff, “is terrified of going through a puberty that is completely foreign to him,” and, “his anxiety is growing.” Victor loves video games, is passionate about music, and he hopes to be a marine biologist.

Victor’s parents, Vanessa and Vance, “cannot bear to witness their child go through physical changes that will profoundly harm him.” They “do not wish to uproot their lives, nor can they imagine bearing the long-term financial costs associated with leaving the state to get care for Victor.” If the health care ban continues to remain in effect, the Voe family “will have their lives turned upside down,” the lawsuit says.

The new law being challenged bans widely accepted gender-affirming medical treatments for minors with gender dysphoria, including puberty blockers, hormone therapy, and surgical care.  Additionally, H.B. 808 provides that a violation of the law will be considered “unprofessional conduct” and would lead to the revocation of a medical provider’s license. The law also prohibits state funds, including for North Carolina Medicaid participants, from being used to provide or cover gender-affirming medical care to minors.

National Health Law Program Senior Attorney Catherine McKee, co-counsel in the case, added: “The ban will harm transgender youth and their families across North Carolina, especially those enrolled in Medicaid. To put it plainly, these families lack the financial resources to seek care outside the state or to cover the cost of that care themselves. As a result, HB 808 will force transgender adolescents to forgo the gender-affirming care that both their doctors and parents deem necessary.”

Plaintiff Dr. Riley Smith said, “as a family physician that serves transgender patients, I can confirm that gender-affirming care is lifesaving. This treatment is medically necessary, safe, effective, and supported by every major medical organization in the U.S. Laws banning gender-affirming care will have dire consequences for transgender youth. We do not need politicians in the exam rooms with us, overriding the decisions of families and their doctor or putting our professional licenses at risk for doing our jobs. Instead, providers in North Carolina should be able to provide the highest quality, evidence-based care to their transgender patients, just like we do for our other patients.”

“As a non-binary, transgender North Carolinian myself, this legislation strikes me to my core. It directly affects the state where I have sought and continue to access gender-affirming care, and my heart is heavy for my community here at home who will bear the burden of H.B.808’s harmful restrictions. GLMA is suing the State of North Carolina not only to protect equitable health care access for all individuals, but also to uphold the vital role that health professionals play in fostering healthier communities. This legislation undermines their extensive expertise and ability to perform life-saving work, and it will undoubtedly weaken the entire state’s health system,” said Alex Sheldon (they/them), plaintiff GLMA’s Executive Director. 

“Equality NC stands in solidarity with the hundreds of NC families who were stripped of the right to make private medical decisions. We commend these brave families fighting for the rights of their children. Right now, parents are seeing their children being denied life-saving care because of politics and hate. We believe that access to healthcare shouldn’t depend on politics. Access to healthcare is our birthright and this lawsuit seeks to ensure that every family is treated fairly under North Carolina law,” said Kendra R. Johnson (she/hers), Executive Director, Equality North Carolina. 

“As alleged in our complaint, HB808 is just one of the various laws recently adopted by North Carolina’s legislature that target trans youth for discrimination. Trans youth and their families, like all youth and their families, deserve and are entitled to equal rights. Their healthcare needs should not be political fodder, but rather should be left to be determined by the youth, their families, and their doctors together. Gender-affirming medical care is safe and effective evidence-based care. It should not be banned because the state disapproves of transgender people,” said Omar Gonzalez-Pagan (he/him), Counsel and Health Care Strategist at Lambda Legal. 


On June 28, North Carolina’s Republican-controlled House passed H.B. 808 following the state Senate vote earlier that week. A week later, on July 5, Democratic Governor Roy Cooper vetoed the measure alongside two other anti-LGBT bills, one banning transgender students from interscholastic sports and second banning schools from incorporating LGBTQ-related topics in all classroom teaching. On August 16, the state legislature overrode Gov. Cooper’s veto, and the ban took effect immediately.

This lawsuit follows the steps of a similar case (Kadel v. Folwell) Lambda Legal and co-counsel TLDEF filed in 2022 against North Carolina State Health Plan’s categorical exclusion of medically necessary gender-affirming medical care, which a federal district court found discriminatory and unlawful. North Carolina’s Health Plan and the State Treasurer appealed that decision and the case is currently being reviewed by the Fourth Circuit of Appeals alongside a similar case from West Virginia.

Joining Lambda Legal attorneys Tara Borelli, Omar Gonzalez-Pagan and Sruti Swaminathan are NHeLP lawyers Catherine McKee and Abigail Coursolle; as well as the private law firms HWG LLP (Amy Richardson, Lauren Snyder, and Deepika Ravi) and McDermott Will & Emery LLP (Dmitriy Tishyevich and Anna Fosberg).

More information about Voe v. Mansfield


PFLAG is an organization of LGBTQ+ people, parents, families, and allies who work together to create an equitable and inclusive world. We are hundreds of thousands of people and hundreds of chapters from coast to coast who are leading with love to support families, educate allies, and advocate for just, equitable, and inclusive legislation and policies. Since our founding in 1973, PFLAG works every day to ensure LGBTQ+ people everywhere are safe, celebrated, empowered and loved. Learn more, find support, donate, and take action at PFLAG.org.

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