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Board approves transgender surgery coverage for state workers

Board approves transgender surgery coverage for state workers

From the 2018 year in review: Highs and lows of the past 12 months in the Madison area series

Transgender surgery will be covered for state workers starting Jan. 1 after the board that oversees the benefits narrowly approved the move Wednesday, restoring coverage that existed for a month early last year.

The Group Insurance Board voted 5-4 to cover gender-reassignment surgery and related services. The board, which had not allowed the coverage for years, approved it in 2016, effective the following year, before reversing its decision at the request of Gov. Scott Walker. Now it’s being added again.

“I’ve been waiting so long,” said Rowan Calyx, 46, a transgender man who works at UW-Madison and has an appointment with a UW doctor soon to discuss surgery. “Now that this is actually approved, I can go ahead and feel like this is going to go somewhere, instead of continuing to get disappointed over and over.”

Dr. Wren Logan, a transgender psychiatry resident at UW Hospital, said she also plans to pursue surgery.

“To have the state you’re in, the employer you’re working for, on the same page as you is just this release of tension,” said Logan, 27.

Voting for the coverage were board members Herschel Day, Michael Farrell, Charles Grapentine, Stacey Rolston and Nancy Thompson. Voting no were Waylon Hurlburt, Jennifer Stegall, J.P. Wieske and Bob Ziegelbauer. Bob Wimmer abstained and Theodore Neitzke was absent.

“What we’re talking about is the improved health and well-being of our members for no cost,” said Day, an associate professor of mathematics at UW-Eau Claire, who said the coverage shouldn’t impact premiums.

No members spoke in public against the measure as the board voted in open session after meeting in closed session to discuss legal considerations.

The board’s renewed consideration of the coverage came after two transgender state workers sued the state last year for not having the benefits, and a judge ruled last month that the state can’t bar the use of Medicaid funds to pay for the surgery.

This month, chancellors at UW-Madison and five other UW campuses asked the board to restore the coverage, saying four Big Ten campuses offer it.

UnitedHealthcare, which is starting a Medicare Advantage program for state workers and retirees, told the state its lack of coverage for transgender medical services would cause the company to be out of compliance with federal Medicare rules.

“The legal landscape regarding transgender health care and transgender rights generally has developed further” since December 2016, the last time the insurance board ruled on the issue, according to a Department of Employee Trust Funds memo to the board last week.

ETF’s three largest insurers — Dean Health Plan, WEA Trust and Quartz, which includes Unity, Gundersen Health Plan and Physicians Plus — have started allowing transgender services in their non-state worker business, the memo said.

State worker programs in neighboring states cover transgender services, with restrictions in some cases, the memo said.

The services were not covered for state workers until the insurance board ended a ban on the coverage in July 2016, effective Jan. 1, 2017. ETF attorneys said the coverage was required by federal rules stemming from the Affordable Care Act.

In August 2016, the state Department of Justice, at Walker’s request, asked the board to reconsider, saying the “unlawful” federal rules “improperly interpret” Title IX, which covers discrimination on the basis of sex, as applying to gender identity.

On Dec. 30, 2016, the board decided the coverage, starting two days later, would end if certain legal developments occurred. Four contingencies, including a court ruling invalidating the federal rules, were met Feb. 1, 2017, and the coverage stopped.

At UW Hospital, Dr. Katherine Gast became the first surgeon at UW to offer the full range of transgender surgeries when she started in August 2017, with the goal of establishing a comprehensive gender services program.

A state consultant said last year that coverage of gender-reassignment surgery and related benefits in the $1.5 billion state worker program would cost $100,000 to $250,000 a year, assuming two to five people per year were to use the services.

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