State employee says Florida ignored procedure in putting out transgender Medicaid study
A state employee raised concerns with a top Florida
Medicaid official that the government didn’t follow its standard process in recommending against Medicaid coverage for treatment of gender dysphoria, according to emails included in an ongoing federal lawsuit.
The email, from an analyst with the Agency for Health Care Administration, said the state did not “present an honest and accurate assessment” of available research on such treatment, which has been endorsed by major medical groups, including the American Academy of Pediatrics, the American
Psychological Association and the Endocrine Society.
The emails were included as exhibits in a lawsuit filed in September by health advocacy organizations against the Agency for Health Care Administration challenging a rule, which was adopted in August and prohibits transgender Medicaid beneficiaries from getting coverage for gender-affirming treatments such as puberty suppressants and hormone therapies.
In the latest filing, plaintiffs included an email between Jeffrey English, an analyst with the Agency for Health Care Admin
istration, and Christopher Cogle, the chief medical officer of Florida Medicaid. Cogle emailed English in late June, after the state’s report was already out, to ask if there are standard operating procedures for determining generally accepted professional medical standards (GAPMS) and if Cogle could review them. The medical standards are used when deciding whether a particular treatment should get Medicaid coverage.
After explaining the usual process, English then told Cogle he felt “obligated” to mention that he was not informed, consulted or in any way included in the state’s medical standards assessment for gender dysphoria treatment.
“That particular GAPMS did not come through the traditional channels and was not handled through the traditional GAPMS process,” English said.
In April, the Agency for Health Care Administration’s then-director, Simone Marstiller, directed the agency to begin researching medical standards for treatment of gender dysphoria. The move came the same day Florida Surgeon General Joseph Ladapo released guidance advising against social or hormonal treatment of transgender children. The agency’s report was completed June 2, saying such treatments were “not proven safe or effective.”
The report said there wasn’t enough “quality, supporting evidence” to warrant Medicaid coverage of the treatments.
English said he does not “cherry pick data or studies and would never agree to if I were so asked,” and then said the state’s report does not present an honest assessment of the evidence and practice guidelines.
“I sincerely apologize if I come across as a bit agitated about it, but as the ‘GAPMS guy’ around here, lots of assumptions have been made by those who do not know me well,” English said in his email. “I’m a different sort of person than the author of that report. I can’t speak for them. I conduct myself and my work with integrity and I do not play favorites, yay or nay. Full stop, period.”
A call and email to English on Monday were not immediately returned. Gov. Ron DeSantis’ office referred questions to the Agency for Health Care
Administration, which did not return requests for comments as of Monday afternoon.
The groups suing the state argue that treatments such as puberty blockers and hormone therapies are covered by Medicaid when used to treat other medical issues and that the exclusion for gender dysphoria violates the U.S. Constitution’s guarantee of equal protection by discriminating against transgender individuals.
Also, DeSantis’ budget office recently asked Florida universities to detail the health services that they provide to people seeking gender-affirming treatment.