Miami Herald

State employee says Florida ignored procedure in putting out transgende­r Medicaid study

- BY ROMY ELLENBOGEN rellenboge­ Herald/Times Tallahasse­e Bureau

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.

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