Image Credit: Wilson County Schools & Canva
The Tennessee Conservative [By Paula Gomes] –
One community member exhorted the Wilson County Board of Education to not let the talk or threat of possible lawsuits sway their decision on whether to include gender reassignment surgery in the district’s employee health plan on Monday night.
Following discussion, the board voted unanimously to continue to exclude such procedures.
WCS is self-insured, and as a result, the plan that is administered through Meritain Health on behalf of the district’s 3,000 employees is required to comply with certain federal statutes, one being the Mental Health Parity and Addiction Equity Act (MHPAEA).
The MHPAEA is a federal law ensuring that mental health and substance use disorder benefits be covered equally like any other medical or surgical benefits in health insurance plans.
Last year, the board voted to approve what Director of Schools Jeff Luttrell described as a “Cadillac” health plan from Meritain but with an exclusion against covering gender reassignment surgery. Because the district chose to be self-insured rather than adopt the state plan that covers other state employees, the board must review the policy and vote on any changes on an annual basis.
This year, Meritain requested that the exclusion be dropped.
Citing a risk that the plan could be flagged, Meritain wrote to the board, stating that the gender surgery exclusion should be removed from the district’s health plan because “medically necessary gender affirming care is used for the treatment of gender dysphoria which is a mental health condition defined in the current version of the Diagnostic and Statistical Manual (DSM). Excluding coverage for this mental health condition creates Mental Health Parity risk, which has been a particular focal point for enforcement activity, as well as other discrimination concerns.”
Community members voiced concerns about this recommendation ahead of the May 5th meeting and Zone 6 Board Member Kimberly McGee brought a list of questions from Wilson County residents regarding the inclusion of such surgeries.
One of the questions that McGee asked was if there would be a change in the cost of the plan if the board voted to include sex change procedures.
In response to the question, Luttrell pointed out that costs always have the potential to increase any time the board chooses to provide more coverage. He also reminded board members of ongoing litigation that could have a bearing on the situation.
“This particular item, as you know, is tied up in court,” stated Luttrell. “There’s several cases that I think in the next 6 to 8 months will bring clarification on a lot of this.”
Zone 2 Board Member Dr. Beth Meyers relayed that she had reached out to those at the federal level regarding the MHPAEA and had looked at Medicare, a federal program that has no national coverage for gender reassignment surgery.
Having looked at the regulations released last September governing health parity, Meyers said that while the district’s plan was subject to the act, they were not required to provide surgery, but only mental health benefits at the same level as other health benefits.
The state plan does not include language covering gender reassignment surgery. The board could choose to insure their employees under that plan, but it could cost more than the plan they already have in place.
Board Chair Jamie Farrough said that due to “struggling to fund” the existing plan, they may look at other options especially after hearing from one district employee earlier in the meeting who has had numerous charges related to cancer treatment denied by Meritain.
A WCS employee told the board that she had spent hours on the phone in tears trying to get multiple $3,000 charges covered.
“I’m shocked that Meritain would send to you a recommendation to make changes to what the insurance covers but still continue to deny paying for these tests that my doctors have repeatedly told them are required to show whether or not my cancer treatments are working, ” the employee stated.
About the Author: Paula Gomes is a Tennessee resident and reporter for The Tennessee Conservative. You can reach Paula at paula@tennesseeconservativenews.com.
