Transgender students and the college experience

The campus environment

Nearly two percent of American high school students and about one percent of American college students identify as transgender. However, they experience discrimination and harassment at much higher rates than most students. Transgender students share the same qualities and aspirations as their peers, but their access to basic services and overall college experience differs greatly compared to members of other student populations.

College can play an important role in facilitating a student’s gender identity exploration. Creating an open and accepting environment with support and resources can allow students to navigate this process, while staying in and ultimately graduating college. In response to the need for change, over the last decade, more than a 1,000 colleges and universities have added “gender identity” to their nondiscrimination policies. However, the polices aren’t always enforced and actors aren’t held accountable when transphobic acts take place.

Until approximately five years ago, coverage for any transgender treatment was not considered medically necessary. That was the standard until the DSM-5 — the authoritative medical manual that defines and classifies mental disorders in order to improve diagnoses, treatment, and research — removed Transgender as a form of pathology. That led to several states requiring health insurance to cover “standard” treatments for Gender Dysphoria. Initially this included only hormonal treatment and bottom surgery. In more recent years, top surgery was added to the list of standard treatments. It is currently under debate as to which other surgeries should be included as standard for Gender Dysphoria.

Impacts of transphobic college environments and mental health issues

A 2018 college study of trans-identified students, cisgender LGB students, and cisgender heterosexual students found that transgender students viewed the climate on their campuses as more hostile (i.e., less tolerant and inclusive of them as transgender people), and also reported a lower sense of belonging (i.e., acceptance and integration) within their campus community. Another study found that transgender students tend to present themselves on campus according to their gender binary, rather than their actual gender identity because of concerns for their physical and emotional safety.

Furthering transgender students’ levels of stress is a shortage of campus support as shown by a lack of gender identification on transcripts/official records, gender segregated housing arrangements and a lack of gender inclusive restroom options in campus facilities. Unfortunately, when these forms of stigma and inaction exist, they create difficult environments for transgender people. Which may contribute to problematic affective, cognitive, and behavioral responses, and result in compromised well-being.

In addition to associated mental health conditions, Gender Dysphoria is a Mental Health diagnosis and so falls under the MH Parity Act. The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that generally prevents group health plans and health insurance issuers that provide mental health or substance use disorder (MH/SUD) benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits. As discussed above, top and bottom surgeries are now considered medically necessary treatment for Gender Dysphoria. Surgeries for congenital medical issues are generally covered. In essence, Gender Dysphoria is a congenital Mental Health condition. Therefore, top and bottom surgeries for Gender Dysphoria should also be covered for any plan that covers surgeries for congenital medical issues. There are ongoing debates regarding what is “medically necessary” for transgender members that should be covered beyond that.

Creating a more inclusive college experience

When looking at ways to improve the experience and educational outcomes of transgender students, colleges need to understand that trans environmental microaggressions are often associated with increased risk of negative academic outcomes. Further, according to a Georgia State University study, the risk for suicide increases when microaggressions like gender appropriate housing and restrooms according to gender identity aren’t provided.

By updating policy and improving environments, research has linked the presence of trans-inclusive policies and supports on college campuses to improved transgender students’ psychosocial and academic outcomes. Among the supports that students valued most were gender-inclusive restrooms, non-discrimination policies that are inclusive of gender identity, and the ability to change one’s name on administrative documents.

Becoming a leader in transgender health

Wellfleet has acknowledged that to be a leader in transgender health it must rethink how transgender services are defined and delivered. That’s why we’ve taken action to better support the transgender community. We’ve started with company-wide awareness training, as well as updates to our policies and procedures.

To help with our member-first approach, Wellfleet has created a Transgender Policy Oversight Committee. It is facilitated by the Chief Medical Officer for the implementation, management and oversight of Transgender policy. This committee has helped create clear, simple guidelines for transgender treatments and procedures.

Further, we are seeing that transgender students can have a greater need for access to mental health care. So, we’ve improved student access by offering easy in- and out-of-network access to office and telehealth options. Our new Complete Behavioral Health Solution ensures students have access to behavioral health care when, where, and how they need it.

Updating our coverage policies

Wellfleet wanted to update and clarify its coverage of transgender services. So, we took this opportunity to move away from industry standards and set our own. To meet the needs of our student members, we have to align with what’s best for them. That includes setting a clear and supportive path to provide greater access to the services they need, which is why we’ve developed a member-focused process that gets students the care they need.

Although our clients have the final say on the extent of our coverage, moving forward, top and bottom surgeries should be covered by all of Wellfleet’s fully-insured health plans unless state regulations prohibit coverage of the surgeries. In addition, all transgender services have been categorized and codified for ease and transparency of review.

Contact us, to learn more about how Wellfleet is updating policies to ensure there’s always a Student-first mentality, regardless of gender identity.

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