"Extremely Detrimental": Gender-Affirming Care Providers on Florida's Revised Medicaid Trans Policies

Stock photo of a transgender medical patient
Stock photo of a transgender medical patient Photo by rparobe via Getty Images
Transgender people face more discrimination and harassment than their cisgender counterparts and are twice as likely as lesbian, gay, and bisexual people to contemplate and attempt suicide. Though research shows that gender-affirming care greatly improves the mental health and overall well-being of transgender children and adolescents, Florida Surgeon General Dr. Joseph Ladapo suggested that such treatment is motivated by "political ideology."

Gov. Ron DeSantis appointed Ladapo to the post in September of 2021. In April, Ladapo released a memo that contradicts guidance on gender transition issued by  the U.S. Department of Health and Human Services and advised against social gender transition, hormone therapy, and gender-reassignment surgery as a treatment option for children or adolescents, citing a "lack of conclusive evidence, and the potential for long-term, irreversible effects." On June 2, the Florida Agency for Health Care Administration (AHCA) and the Florida Department of Health announced it would roll back access to gender-affirming care for trans minors and adults, revoking Medicaid eligibility for gender-affirming care and changing state guidelines for gender-affirming care for minors.

On Friday, July 8, the Florida AHCA will meet to vote on the revisions to Florida Medicaid eligibility for transgender adults. These include removing the following from Florida Medicaid coverage for adults and children: puberty blockers, hormone replacement therapy, gender-reassignment surgeries, and "any other procedures that alter primary or secondary sexual characteristics."

Equality Florida estimates that roughly 9,000 transgender Floridians insured with Medicaid could be affected.

Though there are no legislative restrictions that might criminalize trans healthcare in Florida, there are no protections for it, either, which gives providers leeway to deny gender-affirming care. That said, local care providers tell New Times they'll continue to stand by their patients.

Dr. Sheryl Zayas is a family medicine physician and medical director at Care Resource, a nonprofit that operates facilities in Little Havana, Miami Beach, and Fort Lauderdale that provide LGBTQ healthcare. In 2014, the Pride Center in Fort Lauderdale honored her with its Trans Equality Award for her dedication to the transgender community.

She tells New Times she has no plans of stopping the work.

"We will continue to practice evidence-based medicine that includes pubertal suppression and cross hormone treatment in transgender and gender-nonconforming adolescents and adults. Fortunately, the information communicated by the Florida Department of Health are guidelines, and practitioners can still continue to make their own informed decisions about patient care," Zayas says. "The providers who know and love the transgender and gender-nonconforming people will not let them go without care."

That said, enacting these extra steps can make gender-affirming care cost-prohibitive, and placing more barriers on an already marginalized community can make transgender patients become even more disenfranchised and distrustful of the medical community.

"I am certainly concerned about how this information may be perceived by the general population. For young people whose parents are making their healthcare decisions, this could make it less likely for parents to bring their gender dysphoric child into care," Zayas notes. "Creating fear against sound medical practices that show consistent benefit with little risk is bad for everyone. Most people will not go to the resources that exist that refute the claims, and they will instead stay with a general impression of distrust. It makes my job as a practitioner so much harder every day."

The goal, Zayas stresses, is to keep transgender people "off the street." Homelessness is dangerous for all trans people, but trans women in particular face disproportionate murder and HIV rates. According to a study by the Centers for Disease Control and Prevention, four in ten trans women in major U.S. cities tested positive for HIV.

University of Miami assistant professor and care provider Dr. Lydia Fein knows from her years of experience treating transgender patients what can happen when trans people have to resort to other means to obtain gender-affirming care. Even before the announcement was made, Fein has noticed an increase in insurance denials, and patients who had accessed gender-affirming care for years were suddenly receiving pushback from their insurance.

She tells New Times that a Medicaid reversal will be "extremely detrimental." After all, most of her patients rely on Medicaid coverage to pay for care.

"I always teach my medical students that transgender people are people and people need doctors to take care of them," Fein says. "We get focused on gender-affirming care, but we need to make sure we are providing holistic care to patients."

Following Ladapo's announcement, the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of Miami Miller School of Medicine advised providers that it would stick by the guidelines agreed upon by the World Professional Association for Transgender Health and other major medical bodies. In short, the department will not change how it treats patients, regardless of their age or Medicaid status.

"Our immediate fear is that this can easily devolve into chaos in our state," Fein says.

Fein wants trans patients to know that their providers will be there for them.

"I’m a doctor, and my first priority is that I’m always going to take care of my patients. They come first and I’m going to do anything I can to make sure I’m doing best by them," Fein says. "They have somebody in their corner and we are always going to keep fighting."

For Sarah Stumbar, assistant professor in the Department of Humanities, Health, and Society at Florida International University, the only way medical providers can provide care to trans people is to do so in a gender-affirming way.

"Medical students want to learn about these topics because they, nearly universally, recognize their importance in realizing our oaths as physicians — to do no harm. This means knowing how to navigate questions about bodily anatomy, identity, and the medical care of diverse populations," Stumbar says. "I will continue to provide inclusive, holistic, and evidence-based information in my sessions, including any information about new laws governing the care that physicians are able to provide."
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Reina Perez is a freelance writer at Miami New Times. She studied journalism at Nova Southeastern University.
Contact: Reina Perez