Florida Medicaid agency targets transgender treatments

The report from the Agency for Health Care Administration opens the door to coverage being denied for things like hormone therapy.
A group of attendees listen to a speaker during the #ProtectTransKids rally outside Orlando City Hall on Tuesday, June 1, 2021.
A group of attendees listen to a speaker during the #ProtectTransKids rally outside Orlando City Hall on Tuesday, June 1, 2021.
Published June 2, 2022

TALLAHASSEE — The Florida Agency for Health Care Administration issued a report Thursday that could set the stage for the Medicaid program to deny coverage for treatments such as puberty-blocking medication and hormone therapy for transgender people.

The report was the second time in less than two months that Gov. Ron DeSantis’ administration has taken aim at such treatments: The Florida Department of Health in April said the treatments should not be used for transgender youths.

The Agency for Health Care Administration, which oversees the massive Medicaid program, said in a news release that it will start a rule-making process related to treatments for gender dysphoria, which the federal government defines as clinically “significant distress that a person may feel when sex or gender assigned at birth is not the same as their identity.”

Related: Florida advises no social, hormone treatment of transgender children in new guidance

The treatments targeted in the report also include sex-confirmation surgery, with the agency saying they are “not consistent with generally accepted professional medical standards and are experimental and investigational.”

“Following a review of available literature, clinical guidelines and coverage by other insurers and nations, Florida Medicaid has determined that the research supporting sex reassignment treatment is insufficient to demonstrate efficacy and safety,” said the report, which was signed Thursday by state Medicaid director Tom Wallace.

But the stances of the Agency for Health Care Administration and the Department of Health conflict with national medical groups and the Biden administration.

For example, after the Department of Health issued its guidance in April, American Psychological Association President Frank Worrell issued a statement that said the stance “relies not on science, but on biased opinion pieces and cherry-picked findings to support a predetermined viewpoint and create a narrative that is not only scientifically inaccurate but also dangerous.”

“This memo from the Florida Department of Health distorts the psychological science regarding the treatment of gender non-conforming children,” Worrell said. “Research into the treatment of gender non-conforming individuals has found that withholding evidence-based treatments can be psychologically damaging, especially to children and youths who are struggling with their gender identity.”

The Agency for Health Care Administration report Thursday said Florida’s Medicaid program has not had an “explicit policy” about covering puberty-blocking medication, hormone therapy and sex-reassignment surgery to treat gender dysphoria. Other states have a mixture of policies, with some banning coverage and others allowing it.

By law, services provided in the Medicaid program must be deemed “medically necessary.” One test of medical necessity is whether services are consistent with “generally accepted professional medical standards” and are not “experimental or investigational.”

The report’s conclusion that the gender-dysphoria treatments fail that test opens the door to coverage being denied.

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Transgender issues have become a political battleground in recent years in Florida and other states.

Related: DeSantis: NCAA runner-up who lost to trans athlete 'best female swimmer'

As an example, DeSantis in March signed a controversial law that restricts instruction about gender identity and sexual orientation in public schools. Republican supporters dubbed the measure the “parental rights in education” bill, while critics labeled it the “don’t say gay” bill.

Also, in 2021, DeSantis signed a law that prevents transgender females from competing on high school girls’ and college women’s sports teams.

By Jim Saunders, News Service of Florida