Florida moves forward on proposal to deny Medicaid coverage for transgender treatments

TALLAHASSEE, Fla. - Florida Gov. Ron DeSantis’ administration moved forward Friday with a proposal that would deny Medicaid coverage for treatments such as puberty-blocking medication and hormone therapy for transgender people.

The state Agency for Health Care Administration, which runs most of the Medicaid program, published a proposed rule and set a July 8 hearing on the issue. National and state legal and LGBTQ-advocacy groups have vowed to fight the proposal.

The issue centers on treatment for gender dysphoria, which the federal government defines as clinically "significant distress that a person may feel when 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 medication, hormones and hormone "antagonists," sex-reassignment surgeries and any "other procedures that alter primary or secondary sexual characteristics."

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The proposal, published Friday in the Florida Administrative Register, also would establish that such treatments don’t meet a definition of "medical necessity." That is important because, by law, services provided in the Medicaid program must be deemed medically necessary.

The Agency for Health Care Administration on June 2 said it would start the rule-making process and issued a report to back denying coverage of the treatments, which it said were "not consistent with generally accepted professional medical standards and are experimental and investigational."

"Following a review of available literature, clinical guidelines and coverage by other insurers and nations, 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 that trying to bar the treatments was part of a broader push by Republicans to target transgender people. The release of the report was followed by state Surgeon General Joseph Ladapo asking 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 the state’s medical doctors.

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"Governor DeSantis’ agencies have misrepresented findings and distorted data to advance a political agenda, rather than relying on good science," Jon Harris Maurer, public policy director for the LGBTQ-advocacy group Equality Florida said in a June 2 statement. "This is yet another state agency being used to launch an overt attack on transgender Floridians. The transgender community, like all people, shouldn’t have their access to basic, medically necessary, and often life-saving care stripped away by extremist politicians hoping to stoke right-wing fervor. Florida should put public health over politics."

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

"Should AHCA (the Agency for Health Care Administration) follow through on its clear intent to engage in a sham rulemaking 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 health care coverage," the organizations said in a statement.

The AHCA report said Florida’s massive Medicaid program has not had an "explicit policy" about covering such treatments. Other states have a mixture of policies, with some banning 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 at a Florida Department of Transportation auditorium in Tallahassee, according to the information published Friday.