Medicaid for Florida’s transgender youth at risk under Gov. DeSantis

Gershon Harrell
The Gainesville Sun

Cai Husband was only in fifth grade when she told her mother that she wasn't comfortable in her own skin.

Assigned male at birth, Cai expressed how she was struggling internally with her gender identity and didn’t know how to live her life as a young man.

They called the pediatrician and had an emergency visit, which led to a pediatric endocrinologist and gender psychologist. The diagnosis: gender dysphoria, which the American Psychiatric Association defines as a symptom an individual experiences distress between their biological sex and gender identity.

“She was having struggles of feeling like she couldn’t go on if she was going to go through male puberty because that was not who she was inside,” said Cai’s mother, Amanda Husband. 

The Husband family was luckier than most. With access to health care, they were able to meet with physicians and get the assistance they needed. But that may no longer be the case for others in similar situations under a new proposal from Gov. Ron DeSantis’ administration.

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Will transgender youth lose access to medications?

On June 2, the Agency for Healthcare Administration released a 46-page report titled “Generally Accepted Professional Medical Standards Determination on the Treatment of Gender Dysphoria.” It was compiled by six medical professionals who claim that there is not enough evidence that sex reassignment through medical intervention is a “safe and effective” treatment for those experiencing gender dysphoria.

The change, some fear, means transgender youth will also lose access to hormones and puberty blocker medications.

The document is a follow-up to the Florida Department of Health’s guidance released on April 20 that sought to “clarify evidence” on treating gender dysphoria for children and adolescents.

FDOH states that social-gender transition shouldn’t be a treatment option for children under 18, nor should hormone therapy or gender reassignment surgery. It further states that “encouraging mastectomy, ovariectomy, uterine extirpation, penile disablement, tracheal shave, the prescription of hormones which are out of line with the genetic make-up of the child, or puberty blockers, are all clinical practices which run an unacceptably high risk of doing harm.” 

Protesters in support of transgender rights rally outside the Alabama State House in Montgomery, Alabama, on March 30, 2021.

Michael Haller, the chief of pediatric endocrinology at the University of Florida Health, said the 46-page document is the next step to further restrict access to medical services for trans people. 

Moving forward, he added, the Medicaid office may be instructed to not treat gender-affirming hormone therapy as a standard practice, which would lead to hormone treatments no longer being covered under Medicaid. 

“The problem is that once again, the state has chosen to review the available evidence with a heavy bias against the use of gender-affirming therapies,” Haller said. “When, in fact, the evidence is quite robust and supported by every major medical association that these therapies are appropriate for these children.”

Florida government’s role in allowing care

Florida Surgeon General Joseph Ladapo has also requested for the Florida Board of Medicine to review and create policies that would restrict gender-affirming care for transgender youth. 

The 15-member board gives licenses to physicians and doctors around the state and sets guidelines that medical practitioners have to follow. The board also has the ability to revoke licenses if a physician doesn’t follow rules and guidelines. 

Haller said it’s a slippery slope, one that could be problematic.

“In medicine, we hold the doctor-patient relationship to be sacrosanct,” he said. “We’re supposed to be doing what’s best for the individual patient in front of us and considering all the factors involved.”

UF Health pediatrics department sees about 60% of patients who are covered by Medicaid, and a single dose of injectable puberty blockers could cost around $800 to $1,200 for those without coverage. 

“This report is far more insidious than we’d anticipated,” said Simone Chriss, director of the Transgender Rights Initiative at Southern Legal Counsel. 

She said the memorandum that came from FDOH was specific to minors but the 46-page document would take away gender-affirming care for all individuals seeking Medicaid. 

Chriss, who has a legal partnership with the gender clinic at UF Health in Gainesville, said she comes across many trans youth and families who are on puberty blockers or hormones. 

Pride Day participants hold rainbow flags in Gainesville’s Bo Diddley Plaza in 2019.

“It’s just an immeasurably beneficial medical resource because once you develop secondary sex characteristics, it’s much harder to live your life in accordance with your gender identity and pass,” she said. “Taking away access to these things is going to be really devastating for the most vulnerable youth in our state who are already at a disproportionate risk of depression, suicidal ideation, all of that thing.” 

The Trevor Project, an organization dedicated to suicide prevention, estimates more than 1.8 million LGBTQ youth between the age of 13-24 consider suicide each year in the U.S. – and at least one attempts suicide every 45 seconds.

The organization also states that transgender and nonbinary youth face higher rates of depression, thoughts of suicide and attempting suicide in comparison to cisgender youth in the LGBTQ community. 

“The suicide rates are alarming,” Husband said. “Consider that’s your baby.”

Chriss said taking away access to gender-affirming care could lead to people in the trans community and physicians who have the means to leave the state. 

“I think diversity is important and I think the LGBTQ community contributes a great deal to our society here and so the folks that can leave are already leaving in droves,” she said. “The folks who don’t have the opportunity to leave will be stuck without access to the medical care they need, and in a more dangerous and unsafe position on a daily basis.”