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LGBTQ groups denounce Florida plan to limit transgender care

The Florida Agency for Health Care Administration filed a new rule this month, and it is set to take effect Aug. 21.
Credit: teksomolika - stock.adobe.com

MIAMI — LGBTQ and health groups have denounced a new rule by Florida health officials set to take effect later this month to restrict Medicaid insurance coverage for gender dysphoria treatments for transgender people.

The Florida Agency for Health Care Administration filed the new rule this month, and it is set to take effect Aug. 21, according to online records.

The state agency previously released a report stating that puberty blockers, cross-sex hormones and sex reassignment surgery have not been proven safe or effective in treating gender dysphoria. Tom Wallace, the state’s deputy director of Medicaid, signed off on the report in June.

“It is imperative for states like Florida to step up and ensure our focus remains on the actual evidence, rather than the eminence of a medical society or association,” said Agency for Health Care Administration Secretary Simone Marstiller.

Lambda Legal, Southern Legal Counsel, Florida Health Justice Project and National Health Law Program issued a statement Thursday saying the AHCA is ignoring thousands of public comments and expert testimony by finalizing a discriminatory and medically unsound rule.

“AHCA’s actions, at the behest of Governor (Ron) DeSantis and his political appointees, are morally and legally wrong, as well as medically and scientifically unsound," a joint statement from the groups said. “This rule represents a dangerous escalation in Governor DeSantis’s political zeal to persecute LGBTQ+ people in Florida and particularly transgender youth.”

Nikole Parker, Equality Florida's director of transgender equality said the change is politics, not public health — a relentless attack from politicians and state agencies that are pushing their agenda to garner votes. 

Removing coverage of this healthcare is discriminatory and one of the most intense removals of transgender healthcare seen in the country, she said. 

"We are a marginalized community," Parker said. "We are just trying to figure out where we fit on this earth and trying to be happy like everyone else, and we're just constantly seeing our existence be debated for political gain."

Removing this coverage from 9,000 plus transitions who are on Medicaid, according to a report from UCLA's Williams Institute, is going to cause increased rates of anxiety and depression, she said. 

"It's not going to stop folks from being trans. Let's be honest here," Parker said. "It is simply going to cause folks to have to figure out where to go to get their care. But at the end of the day, politicians should not be in this, and it should just be between medical providers."

It will also have physical impacts, she said, as transgender care has been available for years before this and people have already been receiving this care.

"Imagine just taking a medication for years or decades and then it's no longer available to you how your body adjusts to that," Parker said. "People's health is in extreme danger here."

Transgender medical treatment for children and teens is increasingly under attack in many states where it has been labeled a form of child abuse and where Medicaid coverage is barred. Critics point to the irreversible nature of many elements of gender transition treatment.

Many doctors and mental health specialists argue that medical treatment for transgender children is safe and beneficial and can improve their well-being, although rigorous long-term research on benefits and risks is lacking. Federal guidelines say gender-affirming care is crucial to the health and well-being of transgender and nonbinary children.

Last year, the American Medical Association issued a letter urging governors to block any legislation prohibiting the treatment, calling such action “a dangerous intrusion into the practice of medicine."

In a statement, Florida Agency for Health Care Administration Secretary Simone Marstiller said “we have seen a dangerous mix of politics and medicine from doctors in the Biden Administration and many of our medical societies across the United States."

“It is imperative for states like Florida to step up and ensure our focus remains on the actual evidence, rather than the eminence of a medical society or association,” she said.

Dr. Michael Haller, a University of Florida professor and chief of pediatric endocrinology, said the state and Department of Health have intentionally chosen to misrepresent available data on gender-affirming care or have even sought out biased experts or reviewers. 

The Medicaid rule will restrict access to medical care for a group of very marginalized patients, for political gain rather than their best interests, he said.

"The minute they go and trying to get their medications for gender-affirming care, they are going to be hit with a personal financial responsibility, which for some of these medications is going to very clearly be impossible for them to afford and... essentially exclude them from access to meaningful care," Haller explained. "It's even more hurtful, that it's clearly targeting our lowest income Floridians by virtue of affecting only those on Medicaid."

More than half of roughly 1,000 patients receiving transgender healthcare at UF and the other two major academic health clinics, are on Medicaid, Haller said.

Already, he has experienced confusion from a large number of patients. Many are concerned about payment or whether they're even allowed to receive care. 

"We've had to try and communicate very clearly with a large number of our patients that even with this Medicaid rule going into effect that does not restrict our ability to provide care for them... our ability to prescribe for them," he said. 

Floridians are not just going to sit idly by.

There are many groups in Florida working to identify plaintiffs for lawsuits to block this ruling from taking effect or to limit the length of time it will be in effect, he said. 

"There will definitely be legal action," Haller said.

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