In response to today’s United States Supreme Court ruling in the United States v. Skrmetti case, N.C. Treasurer Brad Briner released the following statement:
“The Court’s ruling in Tennessee’s equal protection case upholds our arguments in the long-running Kadel v. Folwell case here in North Carolina,” said Treasurer Briner. “In its simplest form, this case has always been about ensuring that the State Health Plan can conduct its business in a manner that best serves the members of the Plan. We are thankful that the Supreme Court has affirmed the ability of the Plan to do just that.”
Kadel v. Folwell stems from the exclusion of transition-related medical procedures and medications from the State Health Plan’s health benefits coverage, dating back to the 1990’s. In 2016, the Plan’s then-Board of Trustees, out of concern about proposed federal regulation, effectively provided coverage of these benefits on a temporary, one-year basis by opting to not enforce the exclusion. Coverage of these benefits ended after the conclusion of that year, reverting to the way things had been for nearly 20 years.
Exclusions lists are commonplace in most insurance coverage. Lists include the procedures and medications your health plan will not pay for in an effort to ensure that members receive high-quality care and maintain affordable health coverage. For example, the Plan’s current exclusions list includes GLP-1s when used for weight loss, acupuncture, and durable medical equipment.
The Kadel v. Folwell lawsuit was filed after the transition-related medical procedures and medications were returned to the exclusion list. U.S. District Court and the 4th Circuit U.S. Court of Appeals decisions prevented the Plan from doing this. The Plan appealed these rulings to the United States Supreme Court to preserve the Plan’s to conduct its business according to the wishes of its members.
Based on the decision in Skrmetti today, it is expected the Supreme Court will issue an order in the Plan’s appeal in Kadel reversing the decision of the 4th Circuit and remanding the case. It is anticipated this order will also remove the injunction against the Plan, which would automatically and immediately reimplement the benefit exclusion and require compliance with HB 808 / SL 2023-111. When the Supreme Court’s order is issued in Kadel, the Plan will evaluate the order and work with Aetna, Caremark and the Plan’s other vendors to guarantee the Plan is following the law.