Summary
In August 2022, the Florida Agency for Health Care Administration (AHCA) enacted rule 59G-1.050(7) revoking state Medicaid coverage for treatment of gender dysphoria, including puberty blockers, hormone therapy, and gender-affirming surgeries. This rule and the Florida Boards of Medicine’s administrative bans on trans youth care were supported by the AHCA’s June 2 Generally Acceptable Professional Medical Standards determination, which was the product of a highly nonstandard process uniquely involving anti-trans experts from outside the agency. The rule was promptly challenged in a September 2022 suit against AHCA by plaintiffs Dekker et al. (4:22-cv-00325); a preliminary injunction was denied and the challenged exclusion has remained in effect pending trial in May 2023.
“A conclusion in search of an argument”
On Friday, April 28, 2023, the plaintiffs filed their trial brief (Doc. 199) with over 350 attached exhibits containing information about the AHCA’s anti-trans rulemaking process that was not previously known to the public. This evidence confirms early coordination between the office of Governor Ron DeSantis, the Florida Department of Health, and the AHCA at meetings in early April 2022 (Doc. 200-5). AHCA chief litigation counsel Andrew T. Sheeran was even seeking out anti-trans expert witnesses, including Quentin Van Meter (Pl. 337) and anti-gay conversion therapy provider Miriam Grossman (Pl. 274), prior to FLDOH’s April 20, 2022 anti-trans press release. A series of diagrams dated to June 2022 describe a “Gender Dysphoria/Transgender Health Care Policy Pathway” (Plaintiffs’ trial exhibit 296), “Non-Legislative Pathway” (Pl. 295), and “Projected Rulemaking Timeline” (Pl. 294), beginning with state surgeon general Joseph Ladapo’s April anti-trans guidance and ending in June-September 2022 with “Care Effectively Banned”. This indicates that the AHCA had not initiated an open-ended assessment of evidence on certain medical treatments with the possibility that this evidence could be persuasively robust, but rather that this exclusion was already decided at the outset. Jeffrey English, AHCA’s “GAPMS guy”, called the finding “a conclusion in search of an argument” (Doc. 199). Continue reading →