A panel of appellate judges appeared divided during oral arguments Tuesday over a challenge brought by transgender Medicaid recipients to West Virginia's policy excluding coverage for gender-affirming surgeries.

Before a panel for the U.S. Court of Appeals for the Fourth Circuit, patients argued that the policy violates the Equal Protection Clause because under it, a transgender person with gender dysphoria wouldn't receive coverage for gender-confirming surgeries while a cisgender person would for those same surgeries needed for different conditions.