Transgender welfare rules meeting group meeting as state Medicaid ban faces lawsuit

Written by Kristen Jordan Sexton for

When two Florida medical boards announced plans to begin developing Florida-specific guidelines that physicians providing gender affirming care must follow, state Medicare officials were sued in federal court for a rule that prohibits Medicaid from reimbursing any of the costs of the care.

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

The meeting is scheduled 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 an August 5 decision by members of the Florida Board of Medicine to draft guidelines for the state, a request made by the state’s Surgeon General Joseph Ladabo.

The medical boards had not published a draft of the proposed rule at press time. However, a draft proposal submitted by Ladapo in August would prevent clinicians from providing gender confirmation care to transgender people under the age of 18.

The public meeting announcement was posted Wednesday hours before the law firm Lambda’s Southern Regional Office files a lawsuit in Tallahassee federal court on behalf of August Dekker, Brett Rothstein, “Susan Doe,” a 12-year-old transgender girl, and ” KF” is a 12-year-old transgender boy.

The lawsuit alleges that the ban violates equal protection measures in the United States Constitution as well as the Federal Medicaid Act and the Affordable Care Act. The lawsuit also alleges that the ban violates a requirement of early and periodic screening, diagnosis and treatment benefits that requires Medicaid programs to provide children with services necessary to correct or improve a health condition, if those services are medically necessary.

Carl Charles, a senior attorney with the southern regional office of Lambda Legal, told POLITICO Florida that the transgender sponsorship ban is troubling.

“This is a number 180 for Florida, which is particularly concerning because they have been covering this care without a problem on Medicaid for years,” Charles told the news site. “So taking this positive step in the wrong direction is troubling, to say the least.”

Earlier this summer, Medicaid’s director, Tom Wallace, released what he called a comprehensive report and viewed gender affirmation care as an experiment. The label prevents Medicaid from reimbursing Medicare costs because the state’s safety net program does not provide coverage for experimental treatments.

The ad grabbed headlines in Florida and nationwide as DeSantis continues to make a name for himself nationally as a conservative leader while eyeing a potential presidential bid.

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

Data provided by the Health Care Administration Agency (AHCA) shows the number of adults and children receiving gender affirming care through Medicaid between fiscal year 2017-2018 and through fiscal year 2021-2022. According to federal law, children are defined as beneficiaries under the age of 21 and can record actions performed on patients who are 18, 19 or 20 years old.

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

12 children and 13 adults underwent surgery in the 2021-22 fiscal year Medicaid reimbursed. The most common procedure for both groups was a simple mastectomy with three children and six adults who underwent the procedure sometime between July 1, 2021 and June 30.

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

In all, 15 sex-confirmation surgeries were performed on 12 children and 19 surgeries were performed on adults in FY21-22.

The AHCA provided data showing 1,775 15-minute prescriptions for behavioral therapy services written for 233 children. There were significantly fewer adults receiving 15-minute prescriptions for behavioral therapy services than children with 320 prescriptions written for 33 adults in FY21-22.

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

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

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

A review of fiscal year data shows that more adults write estrogen prescriptions than children. But the same is not true of testosterone.

In fiscal year 21-22, 346 children wrote 925 testosterone prescriptions. By contrast, 143 adults wrote 373 prescriptions during the same time frame. Again, it’s an increase from FY17-18 when 130 kids wrote 330 testosterone prescriptions and 63 adults wrote 174 testosterone prescriptions.

Puberty blockers are only given to children. American Heart Association data shows that 180 prescriptions for puberty blockers were written to 55 children in fiscal year 21-22. This is an increase from FY17-18 when 15 beneficiaries wrote 55 prescriptions.

Kristen 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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