Health plan will follow court order to fund sex transition operations

N.C. House bill aims at protecting consumers from being financially ruined by medical debt


State Treasurer Dale Folwell says the State Health Plan will fund sex transition operations, as required by a recent federal court order. That change will take place even as the order is appealed.

The Health Plan has a benefit exclusion “regarding treatment or studies leading to or in connection with sex transition or modifications and related care.” Because of the court order in a lawsuit titled Kadel v. Folwell, the plan will stop enforcing that exclusion.

“We obviously disagree with the judge’s order that is, in essence, assuming responsibility for determining plan benefits for sex transition operations,” Folwell said in a news release Wednesday. “We’re also disappointed the court decided to stop the case from being heard by a jury of North Carolinians. However, I’ve always said that if the legislature or the courts tell me we have to provide for sex transition operations and treatments, I would.” 

The Health Plan’s exclusion for surgical and hormonal treatments “related to the diagnosis of gender dysphoria” dates back to the 1990s, according to the release. Under Folwell’s predecessor, the Health Plan’s board voted in December 2016 not to enforce the exclusion for a year. That decision expired at the end of 2017.

A lawsuit filed in 2019 aimed to make the change permanent. Judge Loretta Biggs ruled in favor of plaintiffs and against the Health Plan on June 10. “We believe the judge’s order is legally incorrect; therefore it is now being appealed to the United States Court of Appeals for the Fourth Circuit,” according to the release from Folwell’s office.

“Since my first day in office, we’ve been trying to lower health care costs for those that teach, protect, and otherwise serve,” Folwell said. “We’ve been battling the hospital cartel to provide transparent pricing to our members so that they can actually understand what they’re paying for health care. The Board has rightly been about reducing costs and limiting spending to those benefits that do the most good for the most members. This case has always been about protecting the authority of the Board to sustain the Plan for current, future, and retired members and nothing else.” 

“I strongly respect the rule of law,” Folwell added. “So, until it is no longer in force, I must comply with the court’s order.” 

Overseen by Folwell’s department, the State Health Plan provides health care coverage to more than 750,000 teachers, state employees, retirees, current and former lawmakers, state university and community college personnel, and their dependents.  



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