Health Care

NC health plan to cover sex changes, if medically necessary, in 2017

A recent change to the state health plan will allow coverage of gender-changing treatments, including sex change transition surgery and hormone therapy, if they are deemed medically necessary.

While some advocates of gay and transgender rights welcome the move, the incoming state treasurer isn’t happy about it. In particular, Dale Folwell, a Republican who will take office in January, doesn’t like the anticipated cost to taxpayers.

“I pledged to the people of North Carolina that we would reduce the state health plan’s 32 billion dollar debt, provide a more affordable family premium especially for our lowest paid employees and provide transparency to the taxpayers,” Folwell said in an email. “The provision to pay for sex change operations does none of those three things.”

The State Treasurer’s Office oversees the health plan for state employees.

State officials said they had no choice but to add the gender treatments to the insurance coverage for teachers and other state employees because of federal regulations that were finalized in May. The board of trustees for the State Health Plan for Teachers and State Employees voted last Friday to remove previous exclusions that prevented coverage of sex changes, modifications and psychological treatments connected to gender changes.

The change allowing such coverage had to be in effect for the next benefit year, which begins Jan. 1, state leaders said.

“If the Plan did not take action to comply with the federal law and federal regulation, the Plan would have risked losing millions of dollars in federal funding and faced discrimination lawsuits for non-compliance,” said Brad Young, press secretary for the State Treasurer’s Office, in an email.

During the public comment period at Friday’s meeting, North Carolina teacher Jeanne Duwve and her transgender child, Luke Duwve, 17, spoke to the board in support of the coverage. Luke is a biological female and identifies as male.

“I am happy for this one small step forward,” Jeanne Duwve said an interview after the decision.

The costs

The additional coverage will cost the state $350,000 to $850,000 annually, according to estimates by The Segal Group, a consulting firm with headquarters in Atlanta.

In a memo to state officials, the group said it considered the number of adults identifying as transgender in North Carolina, the percentage seeking benefits and the cost of treatments, based on studies. According to its calculations, eight to 24 members under the state’s health plan would use transgender benefits.

Folwell, the new treasurer, said he will conduct an investigation after he takes office about “the true legal and financial implications of this provision and report those findings to the citizens of NC who will be paying for it.” He also questioned the timing of the board of trustees vote Friday, because he said health plan staff members “have known about this for months ... and chose to present it with less than 72 hours notice to the public.”

At Friday’s meeting, the board listened to presentations about gender-related conditions, known as gender dysphoria, and treatment, about proposed benefit changes and about the legal risks of failing to comply with federal rules.

There was a procedural vote to table the motion to a future meeting, but outgoing State Treasurer Janet Cowell, who did not seek re-election, broke a tie and the vote on the resolution passed. Duwve said she was “dismayed” because she thought one board member was trying to delay the vote until after Folwell took office.

Next year

The removal of the exclusions applies only to next year’s plan. The board is expected to consider the plan for 2018 prior to December of next year.

“Realize that in one year we will be revisiting this subject,” Duwve said.

It could be sooner than that, of course, if newly elected President Donald Trump follows through on promises to immediately change the Affordable Care Act, commonly known as “Obamacare.”

Similar actions to add sex change coverage have been taken by health plans in Indiana, Wyoming, Wisconsin and Kentucky. Major insurance companies such as Blue Cross Blue Shield and Aetna also cover gender dysphoria-related treatments, including gender reassignment surgery, if the treatments are deemed medically necessary and meet a set of criteria.

“We are pleased to see the plan be updated to match major employers and other governments around the country in providing critical care for trans employees,” Matt Hirschy, a spokesman for Equality NC, a statewide LGBT advocacy group, said about the North Carolina decision.

Requests for comment from the N.C. Values Coalition, a conservative advocacy group, were not returned.

The Affordable Care Act says that sex discrimination, including on the basis of gender identity, is prohibited in health services and insurance for any provider or program that receives federal funding. Under the new rule, denying or limiting coverage of gender transition-related services is deemed “impermissible discrimination.”

The state health plan covers more than 700,000 teachers, state employees, retirees, current and former lawmakers, state university and community college personnel, state hospital staff members and their dependents.

Madison Iszler: 919-836-4952; @madisoniszler