DeSantis plan to deny trans care under Medicaid spurs tense debate

The hearing in Tallahassee before the Florida Agency for Health Care Administration, or AHCA, focused on gender dysphoria, which the federal government defines as clinically "significant distress that a person may feel when sex or gender assigned at birth is not the same as their identity." It was previously called "gender identity disorder."

No final decision was rendered Friday, but more than 70 public speakers registered to speak, expressing a variety of religious, political and medical views to the panel, with more supporters for the DeSantis administration proposal than critics amid the standing-room only crowd.

Attendees jeered and cheered in competition with each other throughout the two-hour hearing, with one even waving a large American flag whenever anyone spoke in favor of the state's plan. The panel was often having to remind the crowd to maintain decorum, but those on both sides of the issue clapped and booed between speakers, seemingly unfazed by the panel's warnings.

Friday's large turnout for a public hearing underscores the heightened debate over transgender rights, especially when it comes to public health care. DeSantis, a rising GOP star, and leading Democratic lawmakers have elevated the topic into the forefront of political discourse.

It's part of a lengthy list of hot-button policies DeSantis has taken on since being sworn in as governor in 2019 following a razor-thin election victory.

Across Florida and around the country, his moves have been lauded by many conservatives, while being lambasted by many progressives. He is widely considered a top 2024 Republican presidential candidate.

Last year, he signed a controversial proposal — the Fairness in Women's Sports Act — that banned transgender athletes from competing in girls and women's sports. Democrats and LGBTQ+ activists rebuked the measure as harmful and discriminate. Republicans, meanwhile, maintain the law preserves athletic integrity.

More recently, DeSantis proclaimed Sarasota-native Emma Weyant the "rightful winner" of the NCAA 500-yard women's freestyle swimming championship — after she lost to a transgender opponent.

State health officials argue that puberty-blocking medication, cross-sex hormones and sex reassignment surgery for transgender people should not be covered by Medicaid because such treatments have not been proven safe or effective.

They also contend that such treatments do not meet the definition of "medical necessity," a key requirement because, by law, Medicaid services must be deemed medically necessary. The state's position was outlined last month when state health officials released a lengthy report on the issue.

Many supporters championed the report at Friday's hearing and criticized the findings of some medical organizations that support gender-affirming care.

"This is a war on children," said Anthony Verdugo, founder and executive director of the Christian Family Coalition. "These are crimes against humanity. Groomers are using their authority as adults to pressure children and ruin their lives."

Chloe Cole, who traveled from California to testify in favor of the proposed rule, told the panel that she began transitioning to a male, beginning at age 13, and later suffered medical complications. Now 17, she has since stopped the process and is now a female.

"I really didn't understand all the ramifications of any of the medical decisions I was making," Cole said. "I wasn't capable of understanding."

Transgender discrimination?

LGBTQ+ advocates countered that the DeSantis administration's policy toward transgender people is discriminatory and harmful. According to a study by the American Academy of Pediatrics, transgender youth report a higher rate of suicide attempts than their similarly aged peers.

"The proposed rule is about politics, not public health," said Equality Florida Public Policy Director Jon Harris Maurer, who also argued that AHCA lacks the legal authority to rule on the issue.

Nathan Bruemmer, who serves as the LGBTQ Consumer Advocate for the Florida Department of Agriculture and Consumer Services, spoke before the panel in opposition to the proposal.

A transgender man, Bruemmer argued the state must "serve and advocate" for all Floridians, including transgender residents, who he said deserve non-discriminatory healthcare.

"We should not deny any Floridian the ability to thrive," Bruemmer said.

When the proposed Medicaid rules were first published last month, LGBTQ+ advocates and activists immediately denounced them, accusing DeSantis of "politically grandstanding" and blatantly discriminating against the transgender community.

"The Florida Agency for Health Care Administration is willfully misinterpreting studies, ignoring evidence, and lending credence to prejudice," said Sarah Warbelow, Human Rights Campaign Legal Director in a statement issued last month. "In the process, they are putting the state between patients and doctors for no reason other than political grandstanding."

"This rule will harm thousands of Floridians if it goes into effect, and it should be rejected summarily," she added.

LGBTQ+ advocates say as many as 9,000 transgender Floridians could be impacted if denied Medicaid coverage.

The DeSantis administration is also separately asking that the Florida Board of Medicine, which regulates medical doctors statewide, to review their findings and "establish a standard of care for these complex and irreversible procedures" for gender dysphoria.

In his letter to the state medical board, Florida Surgeon General Joseph Ladapo, who oversees the state health department, wrote that it's those who favor transgender treatment that are trying to score political points.

"Florida must do more to protect children from politics-based medicine," Ladapo wrote. "Otherwise, children and adolescents in our state will continue to face a substantial risk of long-term harm."

Transgender medical treatment for children and teens is increasingly under attack in many states where it has been labeled a form of child abuse or subject to various bans.

President Biden actions on trans rights

Last month, President Joe Biden issued an executive order to stymie what his administration calls discriminatory legislative attacks on the LGBTQ community by Republican-controlled states, including Florida. The order, among other provisions, seeks to promote gender-affirming surgery for gay and transgender parents and children and pushes for easing barriers to health care and certain types of treatment for the LGBTQ community.

Tapping money already allocated to federal agencies rather than requiring new funding, Biden said the order is meant to counter 300-plus anti-LGBTQ laws introduced by state lawmakers over the past year alone.

The U.S. Department of Health and Human Services supports, evidence-based, age-appropriate, medically-necessary health care for transgender youth. The stance is also endorsed by the American Medical Association, American Psychological Association and the American Academy of Pediatrics.

Since Arkansas last year became the first state to ban gender-affirming health care for transgender minors, Tennessee, Arizona and Alabama also have barred treatment. Texas, like Florida is looking to enact with its proposed rule, has blocked treatment through administrative action.

Texas Attorney General Ken Paxton has branded gender-affirming care as child abuse.

U.S. Health and Human Services Secretary Xavier Becerra said last month that the Biden administration views the states "attacks on our trans and gender non-conforming youth and their families" as "dangerous and negligent."

"It is interference in people's medical decisions and jeopardizes potentially life-saving care. We must support our youth by ensuring they receive, when appropriate, the gender-affirming care and mental health support they need," he said.

Jason Delgado is a reporter for the USA Today Network-Florida. He's based in Tallahassee. Reach him at [email protected]

LGBTQ+ advocates say as many as 9,000 transgender Floridians could be impacted if denied Medicaid coverage.