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

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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.”

By Mimi Nguyen Ly

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