- March 17, 2023
National medical and legal researchers have issued a report condemning Florida health officials’ plan to block Medicaid coverage for gender-dysphoria treatments, saying the move lacks “any persuasive scientific or medical justification.”
The state Agency for Health Care Administration in June rolled out a proposed rule that would prevent Medicaid reimbursements for treatments such as puberty-blocking medication and hormone therapy for transgender people. The agency last week held a raucous hearing on the plan, with one supporter of the proposal decrying the treatments as “crimes against humanity” and others saying they should be outlawed altogether.
Gov. Ron DeSantis’ administration supported the proposal in a June 2 report whose authors included doctors and researchers who oppose medical care for gender dysphoria. The state report said the Medicaid program “has determined that the research supporting sex reassignment treatment is insufficient to demonstrate efficacy and safety.”
But seven scientists and a Yale law professor have countered with a report that said the state study’s “conclusions are incorrect and scientifically unfounded.”
The critical report was released by Yale School of Medicine researchers and professors, including two who work for the Yale Pediatric Gender Program; a University of Alabama at Birmingham professor of pediatrics and pediatric endocrinology; a University of Texas Southwestern psychiatry professor who works as a psychologist at the Children’s Medical Center in Dallas; and a Yale Law School professor.
“The June 2 report purports to be a review of the scientific and medical evidence but is, in fact, fundamentally unscientific,” the researchers wrote. “We are alarmed that Florida’s health care agency has adopted a purportedly scientific report that so blatantly violates the basic tenets of scientific inquiry. The report makes false statements and contains glaring errors regarding science, statistical methods and medicine.”
The researchers said the state study ignores “established science” and instead “relies on biased and discredited sources, stereotyping, and purported ‘expert’ reports that carry no scientific weight.”
The DeSantis administration blasted the critique.
“This is simply another example of the left-wing academia propaganda machine arrogantly demanding you follow their words and not the clear evidence-based science sitting right in front of you,” Agency for Health Care Administration spokesman Brock Juarez said in an email. “The Yale ‘review’ is a hodgepodge of baseless claims using ‘expert opinions’ that lack any sort of real authority or scientific credibility.”
The proposed rule came as the DeSantis administration and Republican leaders throughout the country target transgender issues in advance of the 2022 elections. The Florida Department of Health in April released guidelines that said treatment such as puberty-blocking medication and hormone therapy should not be used for transgender youths.
But federal officials and a host of medical organizations, including the American Academy of Pediatrics, and clinicians have said gender-affirming care is the accepted standard of care among the medical community that treats adolescents and adults with gender dysphoria.
The federal government defines gender dysphoria as clinically “significant distress that a person may feel when sex or gender assigned at birth is not the same as their identity.”
Under Florida’s proposed rule, which needs to be finalized, the Medicaid program would not cover puberty-blocking medication, hormones and hormone “antagonists,” sex-reassignment surgeries and any “other procedures that alter primary or secondary sexual characteristics.”
But the researchers from Yale and the other institutions said the state report justifying the proposal is a “flawed analysis” that relies on “pseudo-science” by authors whose “testimony has been disqualified in court and who have known ties to anti-LGBTQ advocacy groups.”
The state’s study is grounded in a literature review by Romina Brignardello-Petersen and Wojtek Wiercioch, who concluded that “there is great uncertainty about the effects” of sex-reassignment treatments and that the “evidence alone is not sufficient to support” using such treatments.
The 28-page report by the researchers from Yale and the other institutions said Brignardello-Petersen also has conducted research for the Society for Evidence-Based Gender Medicine, an activist group that opposes standard medical care for gender dysphoria.
The state report “looks very scientific on its face,” Yale law professor Anne Alstott told The News Service of Florida in a telephone interview.
“But if you dig in and really look at their sources, an unbelievable amount of their sourcing is to opinion pieces, letters to the editor, they cited a student blog and one of the quote-unquote experts that they hired is a dentist,” said Alstott, one of the main authors of the report criticizing the state proposal.
The critical report also noted that a document authored by one of the state’s experts, Canadian research scientist and psychologist James Cantor, was “nearly identical” to what appeared to be Cantor’s paid testimony in a West Virginia lawsuit involving legislation barring transgender athletes from sports teams. Cantor worked on the case for the Alliance Defending Freedom, an organization that opposes legal protections for transgender people and same-sex marriage and “defends the criminalization of sexual activity between partners of the same sex,” according to the Yale group’s report.
The state also relied on pediatric endocrinologist Quentin Van Meter, who has advocated for “conversion therapy,” which seeks to change sexual or gender identities of LGBTQ people. The practice has been discredited by major parts of the medical community.
The authors of the state report also failed to disclose whether they were paid for their research, Alstott said. Juarez did not respond to questions seeking information about whether they had received compensation.
Alstott called such conflict-of-interest disclosures a “norm of science.”
Juarez, however, mocked the criticism of the state report.
“We firmly stand by our five evidence-, rather than eminence-, based reports from subject-matter experts, including health care researchers who studied the quality of the evidence that the health-care machine relies upon for ‘gender affirming’ care,” he said.
While the proposed rule would affect the Medicaid program, critics fear it could be a first step toward adopting additional policies targeting transgender treatment that other states have embraced.
For example, Alabama and Arkansas have passed laws banning gender-affirming treatment for minors. The laws are being challenged in court.
In Texas, state health officials have opened investigations into parents who provide gender-affirming care to their children.
Alstott echoed other critics’ concerns that such policies can be especially harmful for what she called a “doubly vulnerable” population.
“They face violence. They face discrimination. And the portion of the transgender population that are on Medicaid are, by definition, financially distressed as well,
so it’s almost hard to imagine a more vulnerable and targeted population,” she said.
Alstott said Florida’s proposed Medicaid rule is discriminatory and violates the state’s own regulatory guidelines.
“It violates the U.S. Constitution. It violates the Florida Constitution. It violates federal statutory law preventing discrimination and it violates Florida statutory law preventing discrimination,” she told the News Service. “So there are at least four legal claims off the bat. And what’s so frustrating is this kind of discriminatory policy is illegal, but the state is barreling ahead with it.”