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Florida Pushes Forward to Ban Gender-Affirming Care for Medicaid Users

Rep. Carlos Smith and Florida Surgeon General Joseph Ladapo
Rep. Carlos Smith (L) and Florida Surgeon General Joseph Ladapo

The state is working on a proposed rule change to its Medicaid program that would bar trans people from having their gender-affirming care covered. 

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As Florida's Department of Health considers cutting off Medicaid coverage for gender-affirming care, state officials have leveled fresh attacks against transgender residents.

Florida Surgeon General Joseph Ladapo, an appointee of Republican Gov. Ron DeSantis, has recommended against providing medical care to transgender youth if it involves transitioning.

The state Agency for Health Care Administration last month released a report deeming gender-affirming care for any patient to be "experimental and investigational" and recommended not allowing Medicaid to cover such care.

But a change in state rules remains in the consideration phase. If the state agency adopts the recommendations, that means there will no longer be Medicaid coverage in Florida for puberty blockers, hormones and hormone antagonists, gender-affirmation surgeries, and other procedures that alter primary or secondary sexual characteristics, according toFlorida Politics.

Last Friday, a meeting was held in Tallahassee about blocking Medicaid reimbursements for those seeking gender-affirming care. Ladapo's new rule was met with significant discussion at the meeting, with people traveling across the state to testify on it.

During the meeting, the state flew in a witness, Chloe Cole, who said she had "de-transitioned" after using puberty blockers and having a double mastectomy. "No child should have to experience what I have," Cole told AHCA officials, according to Florida Politics.

The language in the proposed rule change would also ban physicians from considering gender dysphoria when determining what medical treatments would be necessary for patients.

That's a position that runs directly contrary to the American Medical Association's policy for youth and for adults. Last year, the top medical organization in the country formally urged governors and state legislatures to stop creating barriers for gender-affirming care for youth in a letter to the National Governors Association.

"Decisions about medical care belong within the sanctity of the patient-physician relationship," the AMA letter reads. "As with all medical interventions, physicians are guided by their ethical duty to act in the best interest of their patients and must tailor recommendations about specific interventions and the timing of those interventions to each patient's unique circumstances. Such decisions must be sensitive to the child's clinical situation, nurture the child's short and long-term development, and balance the need to preserve the child's opportunity to make important life choices autonomously in the future."

The fact that Florida continues to pursue a contrary path, even now trying to prevent adults using Medicaid coverage for care, has sparked a political firefight in the Sunshine State.

When the Florida House Democratic Caucus sought answers on how much money was going toward gender-affirmation treatments, Jeremy Redfern, spokesperson for the Florida Department of Health, responded by mischaracterizing care.

"Florida House Democrats support sterilizing children," he tweeted. "There's no other way to characterize this position."

Florida Rep. Carlos Guillermo Smith, the Florida legislature's first gay Latinx member, pushed back at that assertion.

"No," he said. "We support giving parents the right to consult with doctors and get their kids life-saving care recommended by the American Medical Association, the American Academy of Pediatrics and the American Psychiatric Association without the DeSantis regime interfering in their lives."

Redfern responded by dismissing the role of medical expertise in guiding medical decisions.

"Eminence-based medicine. That's what this is. It's not evidence-based medicine," Redfern said. "Rep. Smith comes out in support of sterilizing children as long as a doctor says it's okay."

"Why does the spokesperson for the Florida Dept of Health think he, not parents, should make decisions on their children's doctor-recommended healthcare?" responded Nadine Smith, executive director of Equality Florida. "So much ignorance and arrogance."

Gender-affirming treatments for youth do not necessarily cause sterility. "Puberty blockers are falsely claimed to cause infertility and to be irreversible, despite no substantiated evidence," researchers wrote in The Lancet last year. Also, "infertility is not absolute or universal in transgender people undergoing hormone therapy," according to the University of California, San Francisco. Doctors do advise that people who undergo these procedures consider all the potential implications. And genital surgery is not usually performed on anyone under 18.

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