What we learned in April about the Florida AHCA’s Medicaid transition care exclusion Rule 59G-1.050(7) and subsequent litigation in Dekker v. Weida: Summary

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

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Round two: Gender Analysis calls on Florida Boards of Medicine to stop the trans youth care bans and investigate critical irregularities in the rulemaking process

From:

Zinnia Jones and Heather McNamara
Gender Analysis
Seminole County, Florida

To:

Paul Vazquez, J.D.
Executive Director, Board of Medicine/MQA
4052 Bald Cypress Way, Bin #C03
Tallahassee, FL 32399-3253

Danielle Terrell
Executive Director, Board of Osteopathic Medicine/MQA
4052 Bald Cypress Way, Bin #C06
Tallahassee, FL 32399-3256

Re: Proposed Rules 64B8-9.019 and 64B15-14.014 F.A.C. (“Standards of Practice for the Treatment of Gender Dysphoria in Minors”)

Short title: Gender Analysis FLBOM complaint 2

To the Florida Board of Medicine and Florida Board of Osteopathic Medicine:

This message is a followup to our December 2, 2022 complaint and call for a rule hearing on the Boards’ trans youth care bans (Gender Analysis FLBOM complaint 1). Gender Analysis of Seminole County, Florida reiterates our call for the Boards of Medicine to repeal proposed rules 64B8-9.019 and 64B15-14.014 due to extensive irregularities, undisclosed biases and conflicts of interest during the rulemaking process. We repeat our previous objections as stated in our first complaint, and we now bring to your attention several additional issues that have emerged over the past two months. These recent developments further confirm that the trans youth care bans were the fixed outcome of a fatally compromised process and should be invalidated in their entirety by the Boards at the upcoming February 10, 2023 joint meeting. Continue reading

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Florida’s newest Boards of Medicine appointees wrote an anti-trans letter calling for gender “exploratory” therapy, citing a report of a trans teenager being involuntarily hospitalized for nearly two years

Background

On December 2, 2022, Governor Ron DeSantis appointed pediatric endocrinologist Dr. Monica M. Mortensen to the Florida Board of Osteopathic Medicine, followed by the appointment of pediatric endocrinologist Dr. Matthew R. Benson to the Board of Medicine on December 28. Benson previously spoke in favor of the state Medicaid trans care exclusion Rule 59G-1.050(7) at a July 8, 2022 AHCA meeting, and coauthored a September 23 letter to the Boards of Medicine with Mortensen and seven others in support of the trans youth care bans 64B8-9.019 and 64B15-14.014.

Benson and Mortensen’s positions are relevant to an ongoing issue: although the Boards of Medicine voted to advance the trans youth care ban at the November 4 meeting, it has not yet taken effect. Another joint meeting on the ban will now take place on February 10 in response to calls for a rule hearing from Southern Legal Counsel, ACLU of Florida, Gender Analysis and others. Public comment is now open for the upcoming hearing until February 7 at BOMPublicComment@flhealth.gov. Benson and Mortensen’s letter provides important clues to how they will likely approach this rule and other issues involving gender-affirming care as Board members, and this letter warrants extended analysis. Continue reading

Posted in Ethics, Florida, Gender dysphoria, Health care, Politics and law, Psychology and psychiatry, Regret and detransition, Replies, Rhetoric, Trans youth, Transphobia and prejudice | Tagged , , , , , , , , , , , , , , , , | 1 Comment

Anti-trans group SEGM’s cofounder Stephen Beck is an executive at Bon Secours Mercy Health, the fifth-largest Catholic healthcare network in the US

The rapid emergence of SEGM

The Society for Evidence-Based Gender Medicine (SEGM) is a highly active anti-trans advocacy group founded in January 2020, with members involved in a multi-pronged effort to restrict access to gender-affirming care in Florida as well as other states and nations. SEGM members Romina Brignardello-Petersen and Quentin L. Van Meter contributed two of the five Florida AHCA “expert reports”, cited by the state in support of a Medicaid exclusion of all coverage for gender-affirming care as well as a ban on providers offering any gender-affirming medical treatment to trans minors. Van Meter was present as a state expert at the July 8, 2022 AHCA hearing on the coverage exclusion, along with anti-gay conversion therapist and NARTH member Miriam Grossman whose clinical supervisor is SEGM member Stephen B. Levine (deposition in Brandt v. Rutledge). SEGM advisor Michael Biggs appeared on behalf of the state at the October 28, 2022 joint Florida Boards of Medicine hearing on the trans youth care ban, and SEGM member Patrick K. Hunter on the Board of Medicine voted to advance the ban and strip any exception for use within clinical studies.

Elsewhere, SEGM has been the central subject of subpoenas by the state of Alabama to the American Academy of Pediatrics, WPATH and the Endocrine Society in the trans youth care ban case Boe v. Marshall (Lannin declaration). Alabama demanded a wide variety of SEGM-related materials from these organizations, including any communications regarding two unsuccessful anti-trans resolutions by SEGM at the AAP (AAP subpoena paras. 1-9), Brignardello-Petersen’s AHCA review (WPATH para. 41, ES para. 27), and SEGM members Van Meter, Levine, William J. Malone, and Julia W. Mason (WPATH para. 43). SEGM members Professor Richard Byng and “R. Stephens” (Richard Stephens) are part of the NHS England working group on gender dysphoria as of April 2022, and Dr. Trilby Langton of an SEGM-linked group offering “Gender Exploratory Therapy” is coauthor of the Cass Review’s ongoing systematic review of literature on gender dysphoria in youth.

SEGM and its key members have advocated for this alternative treatment of “exploratory” psychotherapy “open to a range of outcomes”, which they believe should be distinguished from anti-trans conversion therapy; nonetheless, Quentin Van Meter said of SEGM on June 6, 2022 that “what we all agree on is that the affirmation, from social to medical to surgical, is an abomination for these children”. SEGM members Van Meter and Hunter are also members of the Catholic Medical Association, a right-wing organization whose executive director declared in court that CMA’s members could never approve a standard of care allowing medical transition. SEGM cofounders Malone, Mason, and Stephen Beck also coauthored a letter against trans youth care with CMA’s Paul W. Hruz (Malone et al., 2021a); Alabama’s subpoenas to the AAP and WPATH demanded any internal communications about this letter (AAP para. 23, WPATH para. 41) or about Paul Hruz (WPATH para. 43). Continue reading

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Update: Comment period on Florida Board of Osteopathic Medicine trans youth care ban is extended to December 28

The comment period for the Florida Board of Medicine’s proposed ban on gender-affirming medical care for trans youth, Rule 64B8-9.019 (“Standards of Practice for the Treatment of Gender Dysphoria in Minors”), was closed on December 5, 2022. However, because of an error in the Florida Board of Osteopathic Medicine’s public notice on their version of the ban, Rule 64B15-14.014, the comment period on this board’s version of the ban has now been extended until December 28 (WUSF Public Media): Continue reading

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