A state employee claims Florida skirted the process in excluding gender confirmation care from Medicaid

Florida health officials circumvented traditional regulatory channels to draft a report recommending that gender-affirming health care be excluded from coverage under Medicaid, a state employee alleges in an exchange included in new court filings.

The Florida Health Care Administration Agency (AHCA), which controls most of the state’s Medicaid program, wrote in June Report that the available medical literature presents “insufficient evidence” that puberty blockers, hormones, and gender-affirming surgeries are safe and effective treatments for gender dysphoria, and thus excluded them from Medicaid coverage because they are “experimental and investigational.”

ensuing state Al-Qaedawhich went into effect in August, bars transgender youth and adults in Florida from using Medicaid to help pay for any “procedures that alter primary or secondary sexual characteristics” when those procedures are used to treat gender dysphoria, stripping more than 9,000 transgender people in Florida lack access to critical care.

But new court documents were submitted late Friday by plaintiffs in the Case challenging Medicaid exclusion in Florida Allegations from an AHCA staff member that state health officials did not follow customary procedures for developing Generally Accepted Occupational Medical Standards (GAPMS) were included in preparing the June report.

Documents show an email exchange between Christopher R. Coogle, MD, chief medical officer of Florida Medicaid, and Jeffrey English, AHCA staff member, provide evidence of tension within the agency over GAPMS’s recommendation on treatments for gender dysphoria.

Cogle inquires in the June correspondence whether the AHCA has a standard operating procedure for GAPMS recommendations, to which English replies in the affirmative, adding: “If you will permit me, I feel obligated to include this information: I was not informed or consulted, was not involved in any way.” GAPMS has not been written in relation to the treatment of gender dysphoria.”

“The specific GAPMS program did not come through traditional channels nor was it dealt with through the traditional GAPMS process,” English writes.

He continued, “I do not co-opt data or studies and would never consent to it if asked.” “All I can say about this report, as I have read it, is that it does not provide an honest and accurate assessment of the current state of evidence and practice guidance as I understand it in the existing literature.”

Most major medical organizations including the American Medical Association (AMA) and the American Academy of Pediatrics (AAP) agree that gender-affirming healthcare for young people and transgender people is medically necessary, and they have condemn the government’s efforts To introduce politics into medicine.

The AHCA report in June acknowledged that groups like the AMA and AAP support the use of puberty blockers, hormones, and surgeries to treat gender dysphoria, but said “none of these organizations is based on high-quality evidence.”

“Their reputation in the medical community alone does not validate their views in the absence of quality supporting evidence,” the report said.

In his letter to Cogle, English says he apologizes “if I happen to be a little offended about it, but as a ‘GAPMS guy’ here, a lot of assumptions have been made by those who don’t know me well”.

“I am a different kind of person than the author of that report,” English wrote. “I can’t speak for them. I conduct myself and my business with integrity and don’t play preference, yes or no. A complete stop.”

English did not immediately respond to The Hill’s request for comment. The AHCA did not respond to The Hill’s questions about how it developed its GAPMS recommendation for treating gender dysphoria or why the report was not drafted using the agency’s standard operating procedures.

Court documents filed Friday also show that the AHCA decided as recently as 2016 that it could not “categorically exclude puberty” from a prescription for gender dysphoria in transgender youth under Medicaid, even though the agency acknowledged at the time that it was not Able to determine “whether puberty suppression therapy is a health service that complies with generally accepted professional medical standards”.

The filings further revealed that the court denied a request by the state to compel two plaintiffs in the case objecting to the Medicaid exclusion to undergo psychological testing, finding that the state failed to provide evidence that the medical expert chosen is not a “transphobic or skeptical transgender denier.” The application was made only to plaintiffs Susan Doe and KF, both young transgender men under the age of 18, and not to the other transgender plaintiffs in the case, who are in their early 20s.

Florida health officials have been widely accused by medical professionals and LGBTQ advocates of knowingly spreading misinformation and false information about health care to emphasize the gender of youth and transgender people to advance a conservative political agenda.

In addition to establishing state Medicaid policy that explicitly excludes health care coverage for gender confirmation, the Florida Board of Medicine — whose membership consists of physicians appointed by Governor Ron DeSantis (R) — in October I voted to start drafting a rule To ban puberty blockers, hormone therapy, and surgeries for transgender youth under the age of 18.

In April, the state health department issued a guidance The proposal for gender-affirming health care — including social transition, which could include changes as simple as the use of new pronouns — should not be within reach of minors. said at least 10 medical experts whose research was cited in the guidance deputy news In August that their work has been misrepresented.

In a study published Wednesday in New England Journal of MedicineTransgender adolescents and young adults reported increased life satisfaction and fewer symptoms of depression and anxiety after receiving gender-affirming hormone therapy for two years.

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