Transgender treatment rule to face legal fight

TALAHASSEE – A legal battle is looming over a state rule taking effect Sunday that will end Medicaid reimbursements for transgender care such as puberty blockers, hormone therapy and sex reassignment surgery.

Lawyers representing individuals and groups plan to file a federal lawsuit challenging the rule, people involved in the planned case said in interviews this week.

The Agency for Health Care Administration, which largely oversees the Medicaid program, proposed the rule this summer, drawing a strong backlash from the LGBTQ community, many medical groups and doctors who treat people with disabilities. people with gender dysphoria.

The federal government defines gender dysphoria as “clinically significant distress a person may experience when the sex or gender assigned at birth is not the same as their identity.”

According to the agency’s rule, the Medicaid program will not cover puberty-blocking drugs, hormones and hormone “antagonists,” sex reassignment surgeries, and any “other procedures that alter primary or secondary sex characteristics.”

The reimbursement ban will apply to young people and adults seeking such treatment.

The rule will also state that gender-affirming treatments do not meet a definition of “medical necessity.”

This is important because, by law, services provided under the Medicaid program must be considered medically necessary.

Under the rule, reimbursements to medical providers will continue for people who have been authorized to seek treatment until current authorizations expire.

Michael Haller, professor and chief of pediatric endocrinology at the University of Florida, said this week that he and other doctors were “working as quickly as possible to ensure patients have clearances in place” before the rule does not come into effect.

Patients already receiving treatment will be able to continue to receive drugs until their authorization expires, “but my understanding is that anyone who needs a new authorization next Monday will be denied,” Haller said.

“This is a particularly cruel and unusual punishment. Imagine someone coming to the end of their clearance next week and who has been on a blocker for almost a year being told they have no more coverage. .” Haller told the News Service of Florida in a phone interview.

Simone Chriss, director of the Trans Rights Initiative at Southern Legal Counsel, is among the attorneys who intend to ask a federal judge to block the rule.

“There’s really no place to mess with something so awful,” she said in a phone interview Thursday.

Medicaid is jointly funded by the federal and state governments and provides care for low-income people.

The rule “violates a number of laws,” according to Chriss, such as certain provisions of the federal Medicaid Act, the Affordable Care Act, and equal protection rights guaranteed by the U.S. Constitution.

Florida’s plan also discriminates against trans people, Chriss said.

“Cisgender people have access to the same hormones, prescriptions, surgeries, procedures, the exact same treatment and the same care for a number of reasons. So to exclude transgender people or people with gender dysphoria from care that are available to everyone for any other medically necessary reason is blatant gender discrimination, and there’s no getting around it,” Chriss said.

The Medicaid rule is one of a number of policies Governor Ron DeSantis, his administration, and state lawmakers have enacted to target trans people.

The Florida Board of Medicine, at the request of the state Department of Health, is studying a rule that would prohibit doctors from providing gender-affirming care, such as puberty blockers, hormone therapy and surgery, to youth.

Additionally, the Legislature last year passed a law banning trans athletes from participating in women’s and girls’ high school and college sports.

And DeSantis signed legislation this spring, which critics have disparagingly dubbed the “don’t say gay” bill, to restrict how teachers can discuss gender identity and sexual orientation in the schools. This law has been challenged in federal courts.

The actions taken by the state are consistent with actions taken by Republicans across the country.

As his political presence on the national stage continues to grow, DeSantis, who is seeking re-election in November, argues that children are being prematurely allowed into treatments that can have lasting harmful effects.

As an example, DeSantis this month called for doctors who perform gender-affirming surgeries on young people to be prosecuted.

“You don’t disfigure 10, 12, or 13-year-olds because of gender dysphoria,” DeSantis said.

“Eighty percent of problems resolve themselves over time anyway. So why would you do that? I think those doctors need to be sued for what’s going on, I’m sorry.”

Haller and other doctors argue that so-called “top” and “bottom” surgeries on things like breasts are rarely performed on underage girls.

The current widely accepted standard of care for such procedures is a minimum age of 16 for upper surgery and 18 for lower surgery.

Critics accuse DeSantis of using the issue to score political points.

“This is nothing more than a political pile-up. There is no reason to focus on this small, already marginalized population other than for political purposes. The suggestion that this is being done to protect children’s health and doing what is best for families and children is very clearly a culture war being used to support the political aspirations of state leaders,” Haller said.

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