A collection of Yale University professors is fighting against a DeSantis administration plan that would deny Medicaid insurance coverage for treatments including puberty-blockers and hormone therapy for Florida’s low-income transgender individuals.
In a 28-page report coming out of Yale’s School of Law and School of Medicine, researchers at the Ivy League institution rebuked the controversial plan and decried it as a “discriminatory policy” based upon “pseudo-science.” Members of the University of Texas Southwestern and University of Alabama also contributed to the “critical review.”
“Florida’s proposed denial of Medicaid benefits for gender-affirming care is discriminatory against poorer and more vulnerable segments of the population that have no other source of health care coverage but Medicaid and who lack the resources to venture outside of the state,” said Dr. Hussein Abdul-Latif, professor of pediatric endocrinology, University of Alabama at Birmingham.
State health officials in Florida 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 a “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.
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“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’s authors write. “So repeated and fundamental are the errors in the June 2 report that it seems clear that the report is not a serious scientific analysis but, rather, a document crafted to serve a political agenda.”
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The Yale professors’ review lays out a lengthy critique of the state’s position. Among other objections, authors accuse Florida of dismissing “solid medical research” and making policy decisions based on a “faulty understanding” of medical and scientific research.
The review emphatically defends medical treatment for gender dysphoria as “satisfactory” of medical standards and supported by a “robust scientific consensus.”
Review authors also criticized the plan as unlawful under state and federal law, arguing that such a proposal targets transgender Floridians and not cisgender residents.
Florida pushes back
In a statement to USA TODAY – Florida, the Agency for Health Care Administration (AHCA) — which will soon make a decision on the issue — offered a full-throated rebuke of Yale’s findings.
“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,” said AHCA Communications Director Brock Juarez 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.”
In the email, AHCA defended the credibility of its report and highlighted studies that suggest research into treatments such as puberty-blockers and hormone therapy are “very weak” and often without randomized control trials — a factor the state considers the “gold standard” of research into new treatments. The state agency also noted the lack of long-term follow up studies after sex reassignment surgery.
“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,” Juarez added.
DeSantis versus the White House
The looming decision by AHCA is among the latest hot-button policy issue DeSantis has championed 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 bill — 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 discrimination. 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.
The White House, among other elected critics, meanwhile, are firing back. 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, in part, 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.
Yale’s report on Florida is the second of its kind this year. They previously filed a similar report in Texas and Alabama in an effort to challenge “discriminatory laws” based on “misused” science.”
“Florida’s illegal attempt to deny standard medical care to transgender people is the latest in a wave of anti-trans medical bans,” said Yale Law School Professor Anne Alstott. “We were appalled to see that the state ignored the actual science and relied instead on biased and misleading evidence.”
According to the Human Rights Coalition, lawmakers nationwide have filed more than 130 bills addressing transgender rights in 2022 alone.
Jason Delgado is a reporter for the USA Today Network-Florida. He’s based in Tallahassee. Reach him at JDelgado@gannett.com