At its July meeting, the Keith County Board of Commissioners voted to add gender‑dysphoria benefits to the county's employee health plan. Commissioners voted to accept the recommendation delivered by the county's benefits consultant and legal advisor, citing both employee access and potential legal exposure if coverage were denied.

The board's legal advisor, Spencer Stadel, advised commissioners that denying coverage for gender‑dysphoria procedures could expose the county to litigation under mental‑health parity principles and discrimination claims. "Somebody could claim this is a mental‑health issue, and you're denying a mental‑health claim," Stadel said during the discussion, cautioning that such claims have increasing legal traction.

Commission debate focused on two points: whether mental‑health care for people with gender dysphoria would remain covered (commissioners were assured that mental‑health services, such as counseling, would continue to be covered) and whether adding surgical or procedural coverage would increase legal or cost risk. Stadel said mental‑health treatment for people seeking care would be covered now; the board's decision addressed coverage for procedures that affirm gender. He said the county's third‑party administrator and benefits advisor, Meritain Health, had recommended including the coverage, and that adding it would reduce the county's exposure to certain legal challenges.

Some commissioners expressed concern about cost and precedent. One commissioner (Anderson) voted against the motion, citing cost concerns. Other commissioners said they preferred to follow the recommendation of Meritain Health and the county attorney's office. After the roll call, the board approved the change; the chair declared "motion carried."

The board directed staff to notify the consultant and to have the plan documents updated. Commissioners and staff said they would circulate the amended benefit description to county employees and the county's benefits vendor so the change can be implemented in plan administration.

Why it matters: the county's vote changes the formal scope of benefits covered under the county's self‑insured plan and reflects a legal‑risk assessment that denial of medically recommended gender‑affirming procedures could be challenged under parity or discrimination law. The decision also requires updates to plan documents and administration processes before claims are paid under the new language.

The board did not set a separate special funding appropriation for the change at the meeting; staff said cost estimates and the contract amendment would be handled through the county's normal benefits‑administration process.