State officials are intentionally and unlawfully discriminating against transgender people who need medical care, a new lawsuit claims.

The lawsuit was filed Monday by half a dozen state workers who are transgender themselves, or who have transgender children. They are all members of the State Health Plan, which provides health insurance to more than 700,000 North Carolina teachers, state workers, retirees and their families.

They say the State Health Plan discriminates against them by not covering costs related to gender dysphoria, the medical term for when someone identifies as a gender different from their physical sex.

Max Kadel, a transgender man who works at UNC-Chapel Hill, said the State Health Plan will not cover breast-reduction surgery for him, even though it would cover a non-transgender man or woman who wanted the exact same surgery. That message of unequal treatment was echoed by another transgender man who is part of the lawsuit, former N.C. State University employee Sam Silvaine.

“I’ve been sent the message that my medical needs are not valid, and my mental and physical health are not important,” Silvaine said.

Silvaine, Kadel and others spoke at a press conference Monday morning in Durham, outside the federal courthouse where they filed the lawsuit.

Some children of state employees are also affected.

“Without this care, I struggle from depression and anxiety,” said Connor Thonen-Fleck, a 16-year-old from High Point who like Kadel and Silvaine was born female but now identifies and presents himself as male. Thonen-Fleck’s parents both work at UNC-Greensboro, and he and his parents said he would have surgery if it were still allowed by the State Health Plan.

The state changed its rules to allow such procedures in 2017, as well as other gender dysphoria treatments like hormone therapy and counseling — but then in 2018 reversed course and no longer allows for them to be paid for by the State Health Plan.


The State Health Plan is controlled by the state treasurer. When transgender state employees were covered in 2017 it was because in 2016 State Treasurer Janet Cowell, a Democrat, pushed for the plan’s board of trustees to vote to include transgender coverage.

When Dale Folwell, a Republican, replaced her in 2017 he had no plans to let that coverage continue, and the board has not voted to include it since then.

“I pledged to the people of North Carolina that we would reduce the state health plan’s $32 billion debt, provide a more affordable family premium especially for our lowest paid employees and provide transparency to the taxpayers,” Folwell told The News & Observer in late 2016, after he had been elected but before he took office. “The provision to pay for sex change operations does none of those three things.”

Folwell’s spokesman Frank Lester said Monday that he doesn’t typically comment on pending litigation, and also had not yet had the chance to look at the lawsuit. Folwell is among the state officials and entities being sued.

The State of Wisconsin lost a similar lawsuit last year, according to news reports,


Numerous medical authorities recognize gender dysphoria as a legitimate condition, leading transgender members of the State Health Plan to ask if discrimination is the real reason it’s not being covered like other legitimate medical conditions.

“Our plaintiffs are simply asking to be treated equally,” said Taylor Brown, one of the attorneys for Lambda Legal representing them. “Nothing more, nothing less.”

According to the North Carolina lawsuit, gender dysphoria can lead to people becoming depressed or suicidal if not addressed with proper medical treatment“Untreated gender dysphoria often intensifies with time,” the lawsuit says. “The longer an individual goes without adequate treatment, the greater the risk of severe harms to the individual’s health.”

Michael Bunting, an assistant athletic director at UNC-Chapel Hill, is also part of the lawsuit. He’s a UNC grad who has worked there for 30 years and didn’t want to bring the school into the lawsuit, he said, but felt he had no choice to help his 13-year-old son.

His son, identified only as C.B. in the lawsuit, was born female but has identified as male from a young age. He is in 8th grade and came out as transgender to his parents in 2017, at which point they started getting him medical treatments, only to have the cost skyrocket last year when the State Health Plan dropped the coverage.

Bunting said the lawsuit was their only resort after asking the State Health Plan’s board of trustees not to let the coverage go away, to no avail.

“This board is forcing us to make our private lives public,” Bunting said. But he and his wife Shelley decided to come forward, he said, because “our son is the bravest, most empathetic person we know.”

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