State Health Plan Board votes to cover sex change surgery

In response to new federal Affordable Care Act regulations that threaten to pull funding for state health plans that discriminate against transgender policy holders, board eliminates such existing exclusions

Christine T. Nguyen—The North State Journal
Janet Cowell

RALEIGH — The State Health Plan for Teachers and State Employees’ Board of Trustees convened Friday to consider, among other agenda items, removing the blanket exclusion of coverage for gender dysphoria-related medical treatments, most notably gender reassignment surgery. The board, by a unanimous vote except for one abstention, voted to eliminate the exclusion. State Health Plan staff estimate the new coverage will cost the State between $350,000 and $850,000 annually.The board heard presentations on gender dysphoria, a medical term defined as the condition of feeling one’s emotional and psychological identity as male or female to be opposite to one’s biological sex. They also heard a review of new regulations from Health and Human Services (HHS) related to the issue, and the financial implications of not complying with them.North Carolina teacher Jeanne Duwvie and her transgender child, Luke Duwvie, 17, spoke to the board during the public comment period, encouraging members to allow for coverage of gender transitioning therapies and surgery in the state plan.Luke, a biological female, identifies as a male, and Jeanne Duwvie described their struggles in adjusting to her child’s dilemma. Luke suffered from depression and suicidal tendencies once entering puberty. She talked about the family’s medical expenses as they sought care for Luke’s gender dysphoria.Currently, the state employees’ health plan does not cover myriad treatments or devices, including hearing aids, laser eye surgery, cosmetic surgery or cosmetic dentistry. The plan provides health care coverage to more than 700,000 current and former employees and is open to their spouses and their children up to age 26. The state’s teachers, state employees, retirees, current and former lawmakers, state university and community college personnel are all covered under the plan.New federal HHS rules issued in May interpreting section 1557 of the Affordable Care Act for calendar year 2017 dictate that any state health programs receiving federal HHS funds must not discriminate in coverage offerings on the basis of sex in accordance with civil rights laws and Title IX.Outside counsel retained by the State Treasurer’s office, Atlanta attorney Ashley Gillihan, pointed to those rules as reason to eliminate the plan’s exclusion of gender dysphoria coverage. She said it may qualify as noncompliance with the new regulations, and thus threaten federal funding streams. Gillihan said N.C. receives approximately $15-20 million in federal subsidies for the retiree prescription drug program that could be pulled in the event of noncompliance with the new rules, but added the threat is not exclusive to that stream of funding.”The consequences as far as actions outside the [state health] plan could extend as far as Medicaid,” said Gillihan.State Treasurer press secretary Brad Young explained why the board felt the need to take action.”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 noncompliance,” said Young.