DeSantis administration moves forward in denying Medicaid coverage for transgender care

Governor Ron DeSantis’ administration moved forward on Friday with a proposal that would deny Medicaid coverage for treatments such as puberty-blocking drugs and hormone therapy for transgender people.

The state Agency for Health Care Administration, which administers most of the Medicaid program, released a proposed rule and held a July 8 hearing on the matter. National and state legal groups and LGBTQ advocacy groups have pledged to fight the proposal.

The issue centers on treating gender dysphoria, which the federal government defines as “clinically significant distress a person may experience when the sex or gender assigned at birth is not the same as their identity.” .

Under the proposed rule, the Medicaid program would not cover puberty-blocking drugs, hormones and “hormone antagonists,” sex reassignment surgeries, and any “other procedures that alter primary or secondary sex characteristics.”

The proposal, published Friday in the Florida Administrative Register, would also establish that such treatments do not meet a definition of “medical necessity.” This is important because, by law, services provided under the Medicaid program must be considered medically necessary.

On June 2, the Agency for Healthcare Administration said it would begin the rule-making process and released a report to deny coverage for treatments, which it said were “not conform to generally accepted professional medical standards and are experimental and experimental”.

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

But opponents blasted the agency, saying the attempt to ban the treatments was part of a broader push by Republicans to target transgender people. The report’s release was followed by state surgeon general Joseph Ladapo calling on the Florida Board of Medicine to review the agency’s findings and “establish a standard of care for these complex and irreversible procedures.” . The Board of Medicine regulates doctors in the state.

“Governor DeSantis’ agencies have misrepresented findings and distorted data to advance a political agenda, rather than relying on good science,” said Jon Harris Maurer, director of public policy at LGBTQ advocacy group Equality. Florida in a June 2 statement. “This is another state agency used to launch an open attack on transgender Floridians. The transgender community, like everyone else, should not have their access to basic, medically necessary and often life-saving care taken away. by extremist politicians in hopes of stoking right-wing fervor Florida should put public health before politics.

Lambda Legal, the National Health Law Program, Florida Health Justice Project and Southern Legal Counsel have also pledged to fight the proposal.

“If the AHCA were to follow through on its clear intention to engage in a bogus regulatory charade, rather than conduct a robust and substantive process that incorporates valid science and is not predetermined, we stand ready to defend the rights of transgender people in Florida, including the right to nondiscriminatory medical coverage,” the organizations said in a statement.

The AHCA report says Florida’s massive Medicaid program has had no “explicit policy” on coverage for these treatments. Other states have a mix of policies, with some prohibiting coverage and others allowing it.

The proposed rule could ultimately lead to challenges before a state administrative law judge. The July 8 hearing will be held in a Florida Department of Transportation auditorium in Tallahassee, according to information released Friday.