Florida to Potentially Restrict Medicaid Coverage for Transgender Drugs, Surgery for Youth

Florida to Potentially Restrict Medicaid Coverage for Transgender Drugs, Surgery for Youth
Gov. Ron DeSantis (L) announced Florida's new surgeon general Dr. Joseph Ladapo on Sept. 21, 2021. (Courtesy of Governor's Press Office)
Mimi Nguyen Ly

Florida Gov. Ron DeSantis’s administration has taken steps toward a potential restriction of the state’s Medicaid coverage for transgender substances or transgender surgery for youth, saying that there was “insufficient evidence” for such approaches to treat gender dysphoria.

The Florida Agency for Health Care Administration (AHCA), which is responsible for regulating Medicaid in the state, issued a 46-page report (pdf) on June 2 reviewing medical evidence related to “gender-affirming care” for people who experience gender dysphoria—a condition where a person identifies differently to their birth gender.

Currently, Florida Medicaid does not have a specific policy on Medicaid coverage for transgender treatments, but the coverage is determined based on generally accepted professional medical standards (GAPMS). The report noted that as a condition of Medicaid coverage, sex reassignment treatment must be “consistent with [GAPMS] and not experimental or investigational.”

It ultimately concluded that the several treatment approaches for gender dysphoria—such as sex reassignment surgery, cross-sex hormones, and puberty blockers—are “not consistent with [GAPMS] and are experimental and investigational with the potential for harmful long term effects.”

The report said there is “insufficient evidence that sex reassignment through medical interventions is a safe and effective treatment for gender dysphoria.” It said the available evidence showed that the interventions cause “irreversible physical changes and side effects that can affect long-term health.”

Tom Wallace, the deputy secretary for Medicaid at the Florida AHCA, signed off on the report.

The AHCA said in a release (pdf) that it “will now initiate the rulemaking process regarding the Medicaid program’s coverage treatments for gender dysphoria.”

Following the report’s publication, Florida’s surgeon general, Joseph Ladapo, asked the state’s medical board to review AHCA’s findings and establish a standard of care for youth who may seek the “complex and irreversible procedures.”

“While some professional organizations, such as the American Academy of Pediatrics and the Endocrine Society, recommend these treatments for ‘gender affirming’ care, the scientific evidence supporting these complex medical interventions is extraordinarily weak,” he wrote in his letter (pdf) to members of the board.

“Florida must do more to protect children from politics-based medicine,” he added. “Otherwise, children and adolescents in our state will continue to face a substantial risk of long-term harm.”

The latest AHCA report is a follow up to guidance (pdf) from the Florida Department of Health released in April that said there was a lack of conclusive evidence in various directives and “fact sheets” from the Biden administration for the coverage of “gender affirming care” for children and adolescents with gender dysphoria.
At the time, Ladapo said that the Biden administration’s guidance “shows that this was never about health care,” and was instead “about injecting political ideology into the health of our children.”

“Encouraging mastectomy, ovariectomy, uterine extirpation, penile disablement, tracheal shave, the prescription of hormones which are out of line with the genetic make-up of the child, or puberty blockers, are all clinical practices which run an unacceptably high risk of doing harm,” stated the guidance from Florida’s health department.

The American Medical Association, a lobbying group of doctors and students, last year sent a letter (pdf) to the National Governors Association urging member governors to “oppose state legislation that would prohibit the provision of medically necessary gender transition-related care to minor patients.” The letter said such action is “a dangerous intrusion into the practice of medicine.” It also said it is “imperative” that minors who have gender dysphoria “be given the opportunity to explore their gender identity under the safe and supportive care of a physician.”
Florida Gov. Ron DeSantis, a Republican, has previously taken actions related to transgender youth. On May 31, he signed into law a measure to ban transgender athletes from competing in women’s sports at schools and universities in the state. In late March, he signed into law the Florida Parental Rights in Education Bill that bans discussions in classrooms about “sexual orientation or gender identity ... in a specified manner" in kindergarten through third grade.