Shadow report targets Florida plan to block Medicaid coverage for transgender treatments

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National medical and legal researchers released a report condemning Florida health officials’ plan to block Medicaid coverage for gender dysphoria treatments, saying the move had “no compelling scientific or medical justification “.

The state Agency for Health Care Administration launched a proposed rule in June that would prevent Medicaid reimbursements for treatments such as puberty-blocking drugs and hormone therapy for transgender people. The agency last week held a raucous hearing on the plan, with one proponent of the proposal denouncing the treatments as “crimes against humanity” and others saying they should be banned altogether.

Governor Ron DeSantis’ administration backed the proposal in a June 2 report whose authors included doctors and researchers who oppose medical care for gender dysphoria. The state report says the Medicaid program “has determined that the research supporting sex reassignment treatment is insufficient to demonstrate efficacy and safety.”

But seven scientists and a Yale law professor hit back with a report that the state study’s “findings are incorrect and scientifically baseless.”

The critical report was published by researchers and professors from the Yale School of Medicine, including two who work for the Yale Pediatric Gender Program; a professor of pediatrics and pediatric endocrinology from the University of Alabama at Birmingham; a professor of psychiatry from the University of Texas Southwest who works as a psychologist at Children’s Medical Center in Dallas; and a Yale Law School professor.

“The June 2 report purports to be a review of scientific and medical evidence but is, in fact, fundamentally unscientific,” the researchers wrote. “We are alarmed that the Florida health agency has adopted a purportedly scientific report that so flagrantly violates fundamental principles of scientific research. The report makes false statements and contains glaring errors regarding science, statistical methods and medicine.

The researchers said the state study ignores ‘established science’ and ‘instead relies on biased and discredited sources, stereotypes and so-called ‘expert’ reports that carry no scientific weight. “.

The DeSantis administration lambasted the criticism.

“This is just another example of the left-wing academic propaganda machine arrogantly demanding that you follow their words and not the clear, evidence-based science that is right in front of you,” the spokesperson said. of the Agency for Health Care Administration, Brock Juarez, in an email. “The Yale ‘review’ is a hodgepodge of baseless claims using ‘expert opinions’ that lack any kind of real authority or scientific credibility.”

The proposed rule came as the DeSantis administration and Republican leaders across the country target transgender issues ahead of the 2022 election. Florida’s Department of Health issued guidelines in April that treatments such as drugs puberty blockers and hormone therapy should not be used for transgender youth.

But federal officials and a host of medical organizations, including the American Academy of Pediatrics, and clinicians have said gender-affirming care is the medical community’s accepted standard of care that treats teens and adults with the disease. of gender dysphoria.

The federal government defines gender dysphoria as “clinically significant distress a person may experience when the sex or gender assigned at birth is not the same as their identity.”

Under Florida’s proposed rule, which needs to be finalized, the Medicaid program would not cover puberty-blocking drugs, hormones and hormone “antagonists,” sex reassignment surgeries, and “any other procedure that alters sex characteristics.” primary or secondary.

But researchers from Yale and other institutions said the state report justifying the proposal is a “flawed analysis” that relies on the “pseudo-science” of authors whose “testimony was disqualified before the court.” court and who have known links to anti-LGBTQ advocacy”. groups.”

The state study is based on a review of the literature by Romina Brignardello-Petersen and Wojtek Wiercioch, who concluded that “there is great uncertainty about the effects” of sex reassignment treatments and that “the evidence alone are not sufficient to support” the use of these treatments. .

The 28-page report by researchers from Yale and other institutions says Brignardello-Petersen also conducted research for the Society for Evidence-Based Gender Medicine, an activist group that opposes standard medical care for gender dysphoria.

The state report “looks very scientific at first glance,” Anne Alstott, a Yale law professor, told the News Service of Florida in a phone interview.

“But if you dig and really look at their sources, an incredible amount of their sources consist of opinion pieces, letters to the editor, they quoted a student blog and one of the quote-unquote experts that they hired is a dentist,” said Alstott, one of the lead authors of the report criticizing the state’s proposal.

The critical report also noted that a document authored by one of the state’s experts, Canadian researcher and psychologist James Cantor, was “nearly identical” to what appeared to be Cantor’s paid testimony in a trial in Virginia. -Western involving legislation banning transgender athletes from sports teams. . Cantor worked on the case for the Alliance Defending Freedom, an organization that opposes legal protections for transgender people and same-sex marriage and “advocates the criminalization of sexual activity between same-sex partners,” according to the report. of the Yale group.

The state has also relied on pediatric endocrinologist Quentin Van Meter, who has advocated for “conversion therapy,” which seeks to change the sexual or gender identities of LGBTQ people. The practice has been discredited by much of the medical community.

The authors of the state report also failed to disclose whether they were paid for their research, Alstott said. Juarez did not respond to questions asking for information on whether they had received compensation.

Alstott called these conflict of interest disclosures a “scientific standard.” Juarez, however, scoffed at the criticism of the state report.

“We stand firmly by our five reports based on evidence, rather than the eminence, of subject matter experts, including healthcare researchers who have studied the quality of evidence on which the healthcare machine s ‘support for ‘gender-affirming’ care,” he said.

While the proposed rule would affect the Medicaid program, critics fear it is a first step toward enacting additional policies targeting transgender treatment that other states have adopted. For example, Alabama and Arkansas have passed laws prohibiting gender-affirming treatment for minors. Laws are challenged in court. In Texas, state health officials have opened investigations into parents who provide gender-affirming care to their children.

Alstott echoed concerns from other critics that such policies can be particularly harmful to what she called a “doubly vulnerable” population.

“They face violence. They are victims of discrimination. And the part of the transgender population that is on Medicaid is, by definition, financially distressed as well, so it’s almost hard to imagine a more vulnerable and targeted population,” she said.

Alstott said Florida’s proposed Medicaid rule is discriminatory and violates the state’s own regulatory guidelines.

“It violates the US Constitution. It violates the Florida Constitution. This violates federal statutory law preventing discrimination and violates Florida statutory law preventing discrimination,” she told the News Service. “So there are at least four legal claims right off the bat. And what’s so frustrating is that this kind of discriminatory policy is illegal, but the state is going after it.

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