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

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Florida Gov. Ron DeSantisโ€™s administration has taken steps toward a potential restriction of the stateโ€™s Medicaid coverage for transgender substances or transgender surgery for youth, saying that there was โ€œinsufficient evidenceโ€ 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 โ€œgender-affirming careโ€ for people who experience gender dysphoriaโ€”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 โ€œconsistent with [GAPMS] and not experimental or investigational.โ€

It ultimately concluded that the several treatment approaches for gender dysphoriaโ€”such as sex reassignment surgery, cross-sex hormones, and puberty blockersโ€”are โ€œnot consistent with [GAPMS] and are experimental and investigational with the potential for harmful long term effects.โ€

The report said there is โ€œinsufficient evidence that sex reassignment through medical interventions is a safe and effective treatment for gender dysphoria.โ€ It said the available evidence showed that the interventions cause โ€œirreversible physical changes and side effects that can affect long-term health.โ€

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 โ€œwill now initiate the rulemaking process regarding the Medicaid programโ€™s coverage treatments for gender dysphoria.โ€

Following the reportโ€™s publication, Floridaโ€™s surgeon general, Joseph Ladapo, asked the stateโ€™s medical board to review AHCAโ€™s findings and establish a standard of care for youth who may seek the โ€œcomplex and irreversible procedures.โ€

โ€œWhile some professional organizations, such as the American Academy of Pediatrics and the Endocrine Society, recommend these treatments for โ€˜gender affirmingโ€™ care, the scientific evidence supporting these complex medical interventions is extraordinarily weak,โ€ he wrote in his letter (pdf) to members of the board.

โ€œFlorida must do more to protect children from politics-based medicine,โ€ he added. โ€œOtherwise, children and adolescents in our state will continue to face a substantial risk of long-term harm.โ€

Byย Mimi Nguyen Ly

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