City of Dallas officials dispute differences in coverage, while LGBT Task Force makes comprehensive trans healthcare a group priority


NOT TRANSPARENT | Trans Pride Initiative President Nell Gaither has disputed discrepancies in transgender healthcare coverage with city officials before, but she said they’re still occurring and need to be addressed before more employees are denied coverage for necessary services and tests. (Anna Waugh/Dallas Voice)


ANNA WAUGH  |  News Editor

It’s been several months since transgender activist Nell Gaither was assured by Dallas officials that the city’s healthcare plan covered everything except surgeries for its trans employees. But Gaither is still finding out that the coverage doesn’t cover as much as it should.

Gaither, president of Trans Pride Initiative, launched a campaign last fall to have the city offer comprehensive transgender health coverage for its employees, including hormone therapy, counseling, wellness exams and gender reassignment surgery.

After meeting with former City Manager Mary Suhm and representatives from Human Resources and UnitedHealthcare earlier this year, she said she was told again that the city’s insurance plan covers everything except gender reassignment surgery — and the city wasn’t likely to cover surgery anytime soon.

She said she thought the city was at least covering everything else and she turned her efforts to education about the need to expand the coverage. But then she found more issues and uncertainties in coverage.

The city’s LGBT Task Force added trans healthcare to its list of priorities this week and will tackle the issue in the coming months, offering Gaither more help with City Hall.

Gaither, who worked for the city for years until last year when she quit to dedicate more time to her nonprofit, is on the city’s COBRA coverage. When she went for an annual checkup in March, she had lab tests to check her estrogen and testosterone levels, which should’ve been covered 100 percent under wellness. But they weren’t.

Gaither fought the charges for months, contacting the city, who directed her to UnitedHealthcare. The insurance company said they were legally prohibited from covering the lab tests under wellness because the tests weren’t listed in their guidelines under wellness coverage. When Gaither again contacted the city, they told her the tests were covered by the negotiated insurance rate, but not under wellness, and therefore not at 100 percent.

“The city said they cover this. My experience is what I was told was covered wasn’t covered,” Gaither said. “So I think that we don’t know what’s covered and what’s not.”

Representatives with Dallas’ Public Information Office, Human Resources and interim City Manager A.C. Gonzalez’s office did not return calls or emails seeking comment.

The discrepancy has brought questions about what else isn’t covered under the wellness umbrella for the city’s coverage and how they will communicate the coverage to trans employees before they get stuck with a bill that they thought they wouldn’t have.

“My health is good so I’m limited to what I can try to cover,” Gaither said about knowing for sure what the city covers.

The city’s insurance coverage has allegedly covered everything for its trans employees minus surgery since 2009, Gaither said, but she and other employees have had trouble getting their hormones covered on the plan for years.

UnitedHealthcare’s prescription drug plan is separate. Gaither said her hormones were sometimes covered based on the prescription provider. CVS/Caremark is the current provider and currently covers her hormones. But she said she hasn’t ever met her deductible for hormones, so she’s unsure if the coverage really does cover them after meeting the deductible.

CVS/Caremark doesn’t list hormone replacement therapy in its exclusions.

Gaither wants the city to explain its trans coverage in writing and publish it online or in print in Human Resources so employees know what is and isn’t covered. That way, when people have issues with coverage, they can prove that a test or service should be covered if they have it in writing.

“They don’t have any statement from the city to back them up,” Gaither said.

And she’d like the city to eventually create a how-to guide for employees who want to transition on the job to know how the city will handle it from prescriptions to changing a gender marker on city records.

Gaither brought the issue to former Councilwoman Delia Jasso’s LGBT Task Force in February to discuss adding gender reassignment surgery to the city’s healthcare coverage and to work on how to better communicate the current everything-but-surgery coverage to employees.

“I wanted it to be a collective effort,” she said.

Although the Task Force discussed trans healthcare, nothing was worked on because things were on hold until after the May election. Things were on hold again after Jasso lost her seat to Councilman Scott Griggs since redistricting placed them in the same district.

But Councilman Adam Medrano was recently appointed by Mayor Mike Rawlings as the Task Force’s new chair. At a meeting this week, members outlined several priorities for the next few months, including trans healthcare.

Medrano is planning several meetings with members and city departments over the next month to discuss issues with the interim City Manager A.C. Gonzalez and the city attorney’s office, among others.

He told Dallas Voice that while comprehensive trans healthcare is a priority of the group going forward, he’s unsure if it will make it onto the budget in the next two months. Council members can recommend budget items before voting on the final budget.

Medrano said a few council members have already expressed support for adding gender reassignment surgery to the insurance coverage and he would continue to push for it.

“It is a priority,” Medrano said. “I will push for it.”

Meanwhile in Fort Worth, the city’s Aetna plan specifically excludes any coverage for trans employees. Comprehensive trans healthcare has been on hold since 2009, when it was the only outstanding recommendation of 21 suggestions from the city’s Diversity Task Force that was created in response to the raid on the Rainbow Lounge.

Fairness Fort Worth leaders met with city officials earlier this year and are waiting for a follow-up meeting to see when, or if, the city will add some coverage for trans employees or complete coverage that includes surgery.

“We’re working on having a meeting with city representatives but it hasn’t happened quite yet,” FFW President David Mack Henderson said.

Leaders previously said their strategy was to get the coverage added without a vote by City Council on the issue because there wasn’t enough support. That route would likely take place with the city manager.

Fort Worth City Manager Tom Higgins did not respond to requests for comment on the possibility of the city adding the coverage.

Even if Dallas can’t add the surgery to the coverage this budget cycle, Gaither said the Task Force can continue to educate city and community leaders on the importance of full coverage for medically necessary procedures.

“That needs to be part of this. This won’t be a done deal until that is included,” Gaither said, adding that she thinks it can be accomplished with the renewed efforts. “I think we’re on our way. It’s just a matter of time.”

This article appeared in the Dallas Voice print edition August 23, 2013.