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Health organizations challenge Florida's Medicaid rule regarding transgender treatments

Transgender pride rainbow waving flag
The rule, proposed by the Florida Agency for Health Care Administration, took effect August 21st. It bars Medicaid from reimbursing medical providers for transgender treatments such as puberty blockers, hormone therapy, and gender-reassignment surgery.

Despite objections from the state, 22 health-care organizations are seeking to bolster a legal challenge to a new Florida rule that prevents Medicaid from paying for treatments such as puberty blockers and hormone therapy for transgender people.

The organizations, such as the American Medical Association, the American Academy of Pediatrics, the American Academy of Family Physicians and the Florida Chapter of the American Academy of Pediatrics, requested approval Tuesday from a judge to file a brief in a lawsuit seeking to block the Medicaid rule.

A copy of the brief, attached to the request, said the rule would “irreparably harm” many Medicaid beneficiaries with gender dysphoria.

“Gender dysphoria is a clinical condition that is marked by distress due to an incongruence between the patient’s gender identity (i.e., the innate sense of oneself as being a particular gender) and sex assigned at birth,” the brief said. “This incongruence can lead to clinically significant distress and impair functioning in many aspects of the patient’s life. If not treated, or treated improperly, gender dysphoria can result in debilitating anxiety, depression, and self-harm, and is associated with higher rates of suicide. As such, the effective treatment of gender dysphoria saves lives.”

Attorneys for the state, however, objected to the organizations’ brief, partly pointing to a hearing U.S. District Judge Robert Hinkle has scheduled Oct. 12 on a motion by plaintiffs for a preliminary injunction against the rule. The state’s attorneys wrote that responding to the brief would “divert time and attention away from that motion.”

Also, they argued that “counsel for the parties are more than able to present arguments and scientific information to this court. Outside assistance is not necessary.”

The rule, proposed this summer by the Florida Agency for Health Care Administration, took effect Aug. 21 and bars Medicaid from reimbursing medical providers for treatments such as puberty blockers, hormone therapy and gender-reassignment surgery. The agency largely runs the state Medicaid program.

Four transgender plaintiffs filed the lawsuit Sept. 7 to challenge the rule, alleging the treatment of gender dysphoria is “medically necessary, safe and effective” for transgender children and adults.

The rule came as Gov. Ron DeSantis and other Republicans in Florida and nationally have taken aim at transgender issues. Florida Surgeon General Joseph Ladapo, for example, has backed a proposal that could restrict doctors from providing treatments to transgender people under age 18. State medical boards are considering that proposal.

The DeSantis administration has defended the new Medicaid rule, relying in part on a report justifying the end of reimbursements for transgender care.

The Agency for Health Care Administration “has done its due diligence” through the report and the rule-making process, agency spokesman Brock Juarez said in an email after the lawsuit was filed.

But the state and national medical organizations dispute the report, which they said in the brief “mischaracterizes the professionally accepted medical guidelines for treating gender dysphoria and the guidelines’ supporting evidence.” While the rule applies to minors and adults in the Medicaid program, the brief focused on minors.

“The widely accepted view of the professional medical community is that gender-affirming care is the appropriate treatment for gender dysphoria and that, for some adolescents, gender-affirming medical interventions are necessary,” the brief said. “This care greatly reduces the negative physical and mental health consequences that result when gender dysphoria is untreated.”

The brief also detailed guidelines used in treating gender dysphoria.

“Decisions regarding the appropriate treatment for each patient with gender dysphoria are made in consultation with the patient, their parents or guardians, and the medical and mental health care team,” the brief said. “There is ‘no one-size-fits-all approach to this kind of care.’”