WCS votes to exclude gender reassignment coverage from insurance plan

Amendments to the Meritain Health insurance plan used by Wilson County Schools were approved in the Monday night board meeting — excluding an option to cover gender reassignment care.

The motion was made by WCS board member Joseph Padilla to approve the plan but exclude page 26, paragraph 25, and seconded by fellow board member Dr. Beth Myers.

Wilson County Schools is self-insured, meaning the board elects what coverage options to offer to employees. Costs of the insurance plans are set aside within the school board budget.

Two paragraphs were added to the health plan document sent by Meritain regarding gender reassignment services and gene therapy. Meritain’s compliance teams recommended WCS include the coverage, and a memo sent out by WCS Deputy Director of Human Resources Rebecca Owens outlined the changes to the health plan.

Paragraph 25, covering gender reassignment services, would provide insurance coverage for people diagnosed with gender identity disorder or gender dysphoria by a physician. Medical services for gender transition, which includes gender reassignment surgery, breast removal, gonadectomy (removal of reproductive organs), breast implants, hormone therapy and psychotherapy were listed as medical necessities.

WCS previously elected not to cover gender reassignment services in employee insurance.

The plan would not cover cosmetic services such as liposuction, calf implants, cheek implants, chin and nose jobs along with others not listed as medical necessities.

The updated plan added a new paragraph 26 covering gene therapy. Examples of gene therapy services include replacing a disease-causing gene with a healthy copy of the gene, inactivating a disease-causing gene and introducing a new or modified gene into the body to help treat a disease.

There is no known financial impact regarding gene therapy until an applicable insurance claim is made, according to Owens. Gene therapy was already covered for WCS employees, but must be pre-approved. The change regarding gene therapy was recommended to provide easier access to medication.

The WCS agenda was made available publicly several days before the meeting, as required by Tennessee state law. The recommendation to include gender reassignment care generated buzz on social media and became a topic of media outlets, including partisan outlets.

“Why this is on the agenda is this is something we annually do,” Jeff Luttrell, WCS Director said. “We look at our plan and determine what we’re going to cover.”

A question brought to board member Kimberly McGee by community members was if the inclusion of the gender reassignment services would increase the cost of coverage or if the exclusion would reduce the cost.

“Any time you add the possibility of more coverage, you have the possibility of costs going up,” Luttrell said.

Luttrell also said that part of his job is to bring the information regarding insurance before the school board every year and the board votes on the items.

“Could [the school] district be dropped from that [insurance] provider if this is not included?” McGee asked, also reiterating the questions asked by community members.

“We pay Meritain based on our plan documents,” Owens said. “We tell Meritain what to pay. They wouldn’t be dropping us because their contract is to pay the bills as we say that they need to be paid.”

Dr. Myers spoke about research she did into federal standards if gender reassignment service coverage was mandatory by law and concluded that, at least with Medicaid, there’s no mandate to cover.

Concerns about compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA) were brought up. The act requires health insurance plans to cover mental health and substance use disorders in a similar way to medical and surgical benefits.

Board member Greg Hohman added that any federal laws regarding that particular care comes down to employers not allowed to discriminate against persons who elect to undergo gender reassignment surgeries. That can be traced back to Title VII of the Civil Liberties Act of 1964.

“Is there a better provider or another provider that we can entertain and look at that might more align with the values we have in Wilson County?” Hohman asked. “I think we need to look at that.”

“I feel like changing plans is a huge deal,” Farough said. “So, before making big changes, I would like to get a legal opinion.”

“I would also like to understand what it means when the insurance company flags us,” Farough added, directed to Owens. “I keep hearing that we might get flagged if we tell Meritain how to do this.”

Owens said that the Department of Labor could flag WCS because of concerns the plan is not compliant with MHPAEA and tell the school district it must include all policies which fall under the act. Owens added she’s unaware if there are fines associated with being flagged.

“I will say when it comes to benefits, I think that the money that we have to spend needs to go toward the needs that we have in the district,” Farough said. “It’s going to be more things like cancer and things like that. That’s what’s in demand here, and that’s what’s needed here.”

WCS board member Melissa Lynn asked if the issue could be deferred to a later meeting to give County Attorney Mike Jennings time to research legal aspects to avoid trouble with compliance.

“I think we just vote on it tonight. Let’s knock it out,” Hohman said.

Community members who attended the meeting applauded Hohman's statement.

The board voted unanimously for approval of the motion.

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