Meeting set for transgender care rules as state Medicaid ban faces lawsuit

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As two Florida medical boards announced plans to start developing Florida-specific guidelines that doctors providing gender-affirming care must follow, state Medicaid officials were sued in federal court for a rule that bans Medicaid from reimbursing for any of the care.

The Florida Board of Medicine and the Florida Osteopathic Board of Medicine, whose members are appointed by Gov. Ron DeSantis, announced Wednesday they would hold a joint public meeting in Tallahassee on Sept. 30.

The meeting is slated for four hours but, according to the announcement, public testimony will be limited to two hours. Additionally, public comments will be limited to three minutes per person. 

The announcement is a follow-up to a decision on Aug. 5 by members of the Florida Board of Medicine to draft state-specific guidelines, a request made by State Surgeon General Joseph Ladapo. 

The medical boards had not published a draft of the proposed rule at press time. However, a draft proposal floated by Ladapo in August would ban physicians from providing gender-affirming care to transgender people under the age of 18. It also would have limited access to gender-affirming care for adults.

Wednesday’s public meeting announcement was published hours before the Southern Regional Office of Lambda Legal filed a lawsuit in Tallahassee federal court on behalf of August Dekker, Brit Rothstein, “Susan Doe,” a 12-year-old transgender girl, and “K.F.,” a 12-year-old transgender boy.

The suit alleges the ban violates equal protection measures in the U.S. Constitution as well as federal Medicaid law and the Affordable Care Act. The suit also alleges the ban violates a provision of the Early and Periodic Screening, Diagnostic, and Treatment benefit that requires Medicaid programs to provide children with the services necessary to correct or ameliorate a health condition, if those services are medically necessary.

Carl Charles, a senior lawyer for the Southern Regional Office of Lambda Legal, told POLITICO Florida the ban on transgender care is troubling.

“This is a 180 for Florida, and is particularly troubling because they’ve been covering this care without issue in their Medicaid program for years,” Charles told the news site. “So to take this affirmative step in the wrong direction is troubling, to say the least.”

Medicaid Director Tom Wallace earlier this summer released what he called a thorough report and deemed gender-affirming care as experimental. The label precludes Medicaid from reimbursing for health care because the state’s safety net program doesn’t provide coverage for experimental treatments.

The announcement grabbed headlines in Florida and nationwide as DeSantis continues to make a name for himself nationally as a conservative leader as he eyes a potential presidential bid.

Meanwhile, state data obtained by Florida Politics and first reported by the Tampa Bay Times show that very few Medicaid beneficiaries in Florida have received receive-gender-affirming care. 

Provided by the Agency for Health Care Administration (AHCA) the data shows the number of adults and children receiving gender-affirming care through the Medicaid program between he state fiscal year 2017-2018 and through state fiscal year 2021-2022. Per federal law, children are defined as beneficiaries under 21 years of age and could capture procedures performed on patients who are 18, 19 or 20 years old.  

Florida Medicaid does not provide any benefits to children without their parent’s consent. 

Twelve children and 13 adults underwent surgical procedures in the Fiscal Year 2021-22 that were reimbursed by Medicaid. The most common procedure for both groups was a simple mastectomy with three children and six adults having undergone the procedure sometime between July 1, 2021, and June 30.

Medicaid covered the removal of the tetnis for two children and two adults and the amputation of a penis for one adult and one child. The safety net program for the poor, elderly and disabled also paid for the surgical construction of two artificial vaginas, one for a child and the other for an adult.

In all, 15 gender-affirming surgical procedures were performed on the 12 children and 19 were performed on adults in FY 21-22.

AHCA supplied data that show 1,775 prescriptions for 15 minutes of behavioral therapy services were written for 233 children. There were far fewer adults receiving prescriptions for 15 minutes of behavioral therapy services than children with 320 prescriptions written for 33 adults in FY 21-22.

However, data show that the number of children and adults receiving the treatment has increased in recent years. For instance, in FY 2017-2018, 1,024 prescriptions for 15 minutes of behavioral therapy services were written for 143 children. 33 adults received 320 prescriptions for the therapy services in FY 17-18.

The data also show that the number of children and adults receiving prescriptions for estrogen and testosterone increased in FY 21-22 from previous years. In 2021, 391 prescriptions for estrogen were written for 151 children compared to 185 prescriptions for 72 children in FY 17-18.

In FY 21-22, 233 adults received 688 estrogen prescriptions. By contrast, 148 adults received 392 estrogen prescriptions in FY 17-18.

More adults are written prescriptions for estrogen than children, a review of the FY data shows. But the same is not true for testosterone.

In FY 21-22, 346 children were written 925 prescriptions for testosterone. By contrast  143 adults were written 373 prescriptions during the same time frame. Again it’s an increase from FY 17-18 when 130 children were written 330 prescriptions for testosterone and 63 adults were written 174 prescriptions for testosterone.

Puberty blockers only are given to children. AHCA data show that 180 prescriptions for puberty blockers were written for 55 children in FY 21-22. That’s an increase from FY 17-18 when 15 beneficiaries were written 55 prescriptions.

Christine Jordan Sexton is a Tallahassee-based health care reporter who focuses on health care policy and the politics behind it. Medicaid, health insurance, workers’ compensation, and business and professional regulation are just a few of the things that keep me busy.

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