Each year, the West Virginia Public Employees Insurance Agency is granted an exemption from the federal Mental Health Parity and Addiction Equity Act. The exemption means the agency can place limits on mental health services that are less favorable than limits on medical/surgical services.
One state senator is working to change that.
Sen. Ryan Weld, R-Brooke, introduced Senate Bill 291, which would require all insurance carriers, including PEIA and managed care organizations, provide mental health parity between behavioral health (including autism), mental health, substance use disorders and medical/surgical procedures.
“I don’t think that people should be limited by their health insurance for the number of times they can see a psychologist or a counselor, or be forced to pay higher deductibles and co-pays for behavioral health treatment,” Weld said. “We don’t limit people — let’s say you have diabetes. We don’t limit the number of times someone can go to the doctor because of that, so why would we limit the number of times someone can go because they suffer from depression or bipolar disorder? It doesn’t make any sense.”
West Virginia has one of the highest substance use disorder rates in the country, as well as high rates of depression. Weld said the state consistently ranks low for mental health parity.
“It’s a wrong that needs to be righted,” he said.
PEIA Director Ted Cheatham disagrees. Cheatham declined to comment for this story through a public information officer, citing ongoing discussions with the Legislature, but during a Senate Health and Human Resources Committee meeting Tuesday, he said he didn’t think the bill was needed.
“What are we trying to solve?” Cheatham said. “We service the people of West Virginia, and we are as close to mental health parity that you can get with one or two exceptions that I will happily outline for you. But we are parity. Our co-pays are the same. We cover in-hospital, out-of-network the same that we do for surgeries, so I don’t see this bill accomplishing anything.”
Responding to Cheatham, Weld said he disagreed that the state has mental health parity and questioned why PEIA files for an exemption each year if they have parity. Cheatham said it was to prevent the agency from being sued. After some back and forth, he added it was because PEIA will not cover gender dysphoria services for mental health reasons. It was the only reason for the exemption he could recall, he said.
Gender dysphoria, according to the American Psychiatric Association, involves a conflict between a person’s physical or assigned gender and the gender with which he/she/they identify. A person may feel uncomfortable in their body or the expected roles of their assigned gender.
It’s different from gender nonconformity, and people with gender dysphoria may often experience significant distress and/or problems functioning associated with this conflict between the way they feel and think of themselves and their physical or assigned gender.
Sometimes people experiencing gender dysphoria undergo gender reassignment surgery and/or hormonal therapy, though some choose to just transition socially. Individual therapy can help a person understand and explore his/her/their feelings and cope with the distress and conflict, the APA says.
Transgender people experience high rates of suicide, especially trans youth. Data from the 2015 U.S. Youth Risk Behavior Survey reveal that 8.6 percent of adolescents report attempting suicide in the past year, and 14.6 percent report having made a plan to attempt suicide. Comparatively, studies have revealed that nearly 25 percent to 30 percent of transgender adolescents report attempting suicide during their lifetimes. Findings from the 2008 National Transgender Discrimination Study revealed that 45 percent of 18- to 24-year-old transgender people had attempted suicide in their lifetimes.
West Virginia has the highest rate of transgender youth per capita.
“When you compile the numbers for adults, we are no longer a top state for transgendered people per capita,” said Andrew Schneider, executive director of Fairness West Virginia. “That means they must be leaving or are living a secret life. We can’t flourish as a state when we are causing our own neighbors to live underground or leave for good, because we need everyone’s talents and contributions to make this the great state that it is.”
Schneider said it’s hard for trans West Virginians to find medical and mental health services in the state; oftentimes they must travel to the larger, nearby metropolises to get the services they need, like Washington, D.C. — if they can afford to travel, that is.
Fairness West Virginia started a transgender health initiative project this year to address the health disparities facing trans West Virginians, creating a network of inclusive medical professionals. Schneider said they’ve made strides, but West Virginia needs to adopt inclusive policies to keep more people in a state hemorrhaging population.
Cheatham did not say why PEIA will not cover gender dysphoria services, but Schneider said it shouldn’t be cost. Many surrounding states, including Kentucky’s state-run insurance program, cover these services. He said San Francisco recently decided to add gender dysphoria service coverage in its insurance coverage and initially raised premiums slightly to cover the added costs. However, at the end of one year of coverage, the city returned funds to payers because they realized they didn’t need the extra funds for additional services.
Overall, mental health parity requirements do not appear to significantly increase insurers’ annual cost per health plan member, according to a 2015 study in the Journal of Mental Health Policy and Economics.
The bill was laid over for the committee to further research the bill. Sen. Ron Stollings, D-Boone, said he wasn’t sure if the bill adequately addressed the issue, though he supports it.
Weld said the committee will pick the bill back up Tuesday.