Rule to ban Medicaid coverage for gender-affirming care draws crowd, ire

A two-hour meeting held Friday in Tallahassee to review a proposed rule that would block Medicaid reimbursements for those seeking treatments such as hormone therapy for transgender people attracted an animated, large crowd.

Residents from across Florida traveled to testify on the rule, including many of whom were in support of the measure proposed by the administration of Gov. Ron DeSantis.

The rule would block the state for reimbursing for various types of treatment including puberty-blocking medication.

There were rounds of applause and boos and chants of “lock them up” during the hearing held at the Department of Transportation auditorium. And while the state Agency for Health Care Administration’s staff asked the public to hold their applause to the end of the testimony, the request was largely ignored.

The first speaker, Chloe Cole, said she has “de-transitioned” after having started the transition process. She was given hormone blockers and said she is not sure whether she will ever be able to have children.

And if she were, she lamented that she would not be able to breastfeed them after having undergone a double mastectomy. Despite having therapists she said she was not able to understand the ramifications of the decisions she was making.

“No child should have to experience what I have,” Cole said. “My consent was not informed.”

Cole, who said she had 30 minutes to catch a flight out of Tallahassee, was rushed out of the meeting. A state employee blocked reporters from asking any questions.

The meeting was held following the state’s announcement that gender-affirming health care for people with gender dysphoria was experimental and would not be covered by the Medicaid program. Until now, there has been no policy for coverage in Florida.

The meeting came after AHCA released a report summarizing what it called a “robust review” of available medical evidence and the assessment of five medical experts who determined gender-affirming care doesn’t meet the generally-accepted professional medical standards.

Medicaid Director Tom Wallace deemed the health care experimental and investigational. The Florida Medicaid program does not cover experimental care, so the finding essentially precludes Medicaid from reimbursing for the services.

The state is proposing to add language to an existing rule that bans Medicaid from providing coverage for gender dysphoria. It excludes coverage of puberty blockers, hormones, and hormone antagonists, sex reassignment surgeries, and other procedures that alter primary or secondary sexual characteristics.

Moreover, the proposed language bans physicians from considering dysphoria and gender-affirming treatment when determining what’s “medically necessary” for their patients.

The underlying rule allows providers to limit the number of Florida Medicaid recipients they treat but makes clear that hospitals cannot refuse to provide emergency care, and providers are precluded from denying services based solely on “race, creed, color, national origin, disabling condition or disability, in accordance with federal anti-discrimination laws.”

If successful, gender dysphoria would be the only diagnosis in the rule for which treatment is banned. But Florida does limit other Medicaid coverage in the rule. For instance, the regulation prohibits Medicaid from providing coverage for people in prison. The rule also makes clear that “aliens” qualify for “emergency” Medicaid services, but once the emergency no longer exists, Medicaid stops providing coverage.

AHCA’s move to ban reimbursement comes after Surgeon General Joseph Ladapo recommended against providing gender-affirming care, including social transitioning, to children.

Ladapo’s recommendations don’t have the weight of law, though, and didn’t apply to Medicaid, which is housed in AHCA.

The American Academy of Pediatrics and the American Medical Association support gender-affirming care for adults and adolescents. But Wallace said the endorsement of the organizations isn’t enough.

While most of the crowd who attended the Friday public meeting spoke in support of the proposed changes, not everyone did. And those who opposed the changes were generally met with boos from the crowd.

Sabrina Hartsfield, who identified herself as a born-again Christian, said religion should not be taken into consideration when pursuing public health policy. She said she knows the damage that denying gender-affirming care can cause.

“Religion ultimately should not be affecting our laws,” Hartsfield said. “I’m going to stand up.”