The Maine Human Rights Commission agreed Monday that the University of Maine system discriminated against a transgender Gorham student when she was denied gender-affirming medical procedures through a health insurance plan the school offered to students in 2019.
The decision was a reversal of the initial vote by the five-member commission in November, when it voted 2-1 to dismiss the case, with one member abstaining and another absent.
One of the members who voted for the dismissal, Jefferson Ashby, disclosed in December that he had a conflict of interest, prompting the commission to review the matter. Ashby did not explain his conflict during the December meeting, only that he was “upset” and apologized to his committee colleagues and the student behind the complaint.
Ashby declined a request for an interview through Amy Sneirson, the commission’s executive director.
Committee members voted 3-1 Monday, with Ashby abstaining, to allow the case to proceed to a 90-day conciliation period during which the university system will work with the complainant on a settlement that does not involve a lawsuit.
The student, who requested anonymity because she fears mental and physical harm if her name is revealed, started at the University of Southern Maine Gorham campus in August 2019 and filed her complaint with the commission in October 2020. She was denied coverage for several claims she submitted to gender care.
During Monday’s meeting, the student’s attorney, Kristin Aiello, said her client, who initially filed her complaint without an attorney, was automatically enrolled in the plan after enrolling in classes, putting the onus on her to disenroll. from medical coverage. If she had chosen to do so, school policy at the time would have required her to provide proof of insurance from another provider, likely at a much higher cost.
At the time, the health plan’s policy had a blanket exemption for gender-affirmation procedures, Aiello told commissioners, deeming them “cosmetic” and unnecessary.
“That’s really important to remember — that was on the list of procedures that were explicitly excluded,” Aiello said. “Period, over, we’re not even going to look to see if it’s medically necessary.”
As of 2019, major medical organizations, including American Medical Association, World Health Organization AND American Academy of Pediatrics, are standing behind gender affirmation procedures as important tools that improve the mental health and well-being of transgender patients. MaineCare began offering coverage for gender affirmation procedures in late 2019.
Deirdre Salsich, the attorney for the university system, told commissioners Monday that the school did not discriminate against the student because the insurance company was a separate legal entity that oversaw the plan and what it included.
“The real issue at hand in this case is an insurance company’s initial denial of coverage for certain medical procedures,” Salsich said. “We had no role in approving or denying any of the medical procedures that (the student) requested as part of her gender-affirming health care.”
Aiello countered that the system failed to negotiate benefits on behalf of its transgender students, noting that the health plan, which covers 30,000 students, contained some college-specific benefits that the university system negotiated related to athletic injuries and its centers student health.
Commissioner Ed David also noted that the university was able to negotiate the terms of the sports and health center and could have done the same for gender-affirming care. Before the student filed her complaint in October 2020, Aiello told commissioners that the student’s mother approached the school that spring to notify the university system that the policy excluded the needs of transgender students.
NEGOTIABLE COVERAGE
“You engaged directly with the broker and said what your requirements were and it was important to you … to negotiate a plan that covered your health centers, that had unlimited coverage for athletic injuries, had these unique bells and whistles for a college campus setting,” said David. “Isn’t that a fair statement?”
“We also explored options that would cover preventive care and primary care for our students,” Salsich said.
“But have you researched the options that cover gender-affirming care?” David asked. “That’s the point.”
The student was eventually able to get coverage after filing complaints directly with the insurance company and the Maine Bureau of Insurance — but it only covered 80% of the cost, Aiello said, and after two and a half years of fighting.
“They could have chosen a different policy,” Aiello said. “They could have negotiated to make sure it didn’t contain discriminatory terms, but they didn’t. They chose this plan based on a number of factors, including no deductibles, no limits on athletic accident claims, but the concerns of the complainant — as a protected transgender student in a protected class — were not raised or discussed when the university negotiated this plan. “
Following the committee’s vote, the University of Maine System released a statement saying they “value each and every one of our students,” “including members of our vibrant LGBTQ+ communities.”
“It is our mission to keep every student safe and healthy,” Tory Ryden, the system’s director of external affairs, said in a written statement. “In light of the commission’s decision this morning, we look forward to the opportunity to resolve this matter.”
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