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Florida employee alleges state ignored process to issue transgender Medicaid study

The email was included in court filings for an ongoing lawsuit challenging the exclusion of Medicaid coverage for gender dysphoria.
On Sunday, August 21, 2022, transgender protester Avani, 28, right-center, rallies the crowd gathered outside the Metro-Dade Firefighters Local 1403 in Doral, Florida, where Gov. Ron DeSantis spoke at a campaign event for school board candidates he endorsed.
On Sunday, August 21, 2022, transgender protester Avani, 28, right-center, rallies the crowd gathered outside the Metro-Dade Firefighters Local 1403 in Doral, Florida, where Gov. Ron DeSantis spoke at a campaign event for school board candidates he endorsed. [ CARL JUSTE | Miami Herald ]
Published Jan. 23|Updated Jan. 24

A state employee raised concerns to a top Florida Medicaid official that the government didn’t follow its standard process in recommending against Medicaid coverage for treatment of gender dysphoria, according to emails included in an ongoing federal lawsuit.

An email from an analyst with the Agency for Health Care Administration said that the state did not “present an honest and accurate assessment” of available research on such treatment, which has been endorsed by major medical groups like the American Academy of Pediatrics, the American Psychological Association and the Endocrine Society.

The emails were included as exhibits in a lawsuit filed in September by a group of health advocacy organizations against the Agency for Health Care Administration challenging a rule, adopted in August, that prohibits transgender Medicaid beneficiaries from getting coverage for gender-affirming treatments, like puberty suppressants and hormone therapies.

Related: When will Florida's ban on gender-affirming care for children begin?

In the latest filing, plaintiffs included an email between Jeffrey English, an analyst with the Agency for Health Care Administration, and Christopher Cogle, the chief medical officer of Florida Medicaid. Cogle emailed English in late June, after the state’s report was already out, to ask if there are standard operating procedures for determining generally accepted professional medical standards, or “GAPMS,” and if Cogle could review them. The medical standards are used when deciding whether a particular treatment should get Medicaid coverage.

After explaining the usual process, English then told Cogle he felt “obligated” to mention that he was not informed, consulted or in any way included in the state’s medical standards assessment for gender dysphoria treatment.

“That particular GAPMS did not come through the traditional channels and was not handled through the traditional GAPMS process,” English said.

In April, the Agency for Health Care Administration’s then-director, Simone Marstiller, directed the agency to begin researching medical standards for treatment of gender dysphoria. The move came the same day Florida Surgeon General Joseph Ladapo released guidance advising against social or hormonal treatment of transgender children. The agency’s report was completed June 2, saying that such treatments were “not proven safe or effective.”

The report said there wasn’t enough “quality, supporting evidence” to warrant Medicaid coverage of the treatments.

English said he does not “cherry pick data or studies and would never agree to if I were so asked,” and then said the state’s report does not present an honest assessment of the evidence and practice guidelines.

“I sincerely apologize if I come across as a bit agitated about it, but as the ‘GAPMS guy’ around here, lots of assumptions have been made by those who do not know me well,” English said in his email. “I’m a different sort of person than the author of that report. I can’t speak for them. I conduct myself and my work with integrity and I do not play favorites, yay or nay. Full stop, period.”

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In a statement sent hours after this story was initially published, the Agency for Health Care Administration said it could not comment on pending litigation but said “it is important to note that the United States has remained behind other nations who have determined that, based on science, ‘gender affirming care’ services remain experimental at best.”

The agency said the GAPMS process followed the applicable rules and procedures.

A call and email to English on Monday were not immediately returned. Gov. Ron DeSantis’ office referred questions to the Agency for Health Care Administration.

The groups suing the state argue that treatments like puberty blockers and hormone therapies are covered by Medicaid when used to treat other medical issues, and that the exclusion for gender dysphoria violates the U.S. Constitution’s guarantee of equal protection by discriminating against transgender individuals.

DeSantis’ budget office also recently asked Florida universities to detail the health services they provide to people seeking gender-affirming treatment.

Note: This story was updated to include a response from the Agency for Health Care Administration.