Expert team provides critical review of Florida medical report on transgender care
As Florida policymakers pursue state-level restrictions on transgender care, legal and medical experts from Yale Law School, Yale Medical School’s Center for the Study of the Child and from the departments of Psychiatry and Pediatrics, the University of Texas Southwest, and the University of Alabama at Birmingham have released a new report that identifies and refutes the many unscientific claims behind the effort. The June 2 report from the Florida Agency for Health Care Administration (AHCA) alleges that nationally accepted standard medical care for gender dysphoria does not meet generally accepted medical standards for coverage. Medicaid. A team of seven scientists and a law professor say the state of Florida’s position is “completely flawed and lacks scientific weight”.
The report, “A Critical Review of Florida Medicaid’s June 2022 Report on the Medical Treatment of Gender Dysphoria,” represents the first comprehensive review of Florida’s June 2 report, which the authors say is a misleading document. intended to justify denial of Florida Medicaid coverage for treatment of gender dysphoria. According to the authors, nothing in Florida’s June 2 report calls into question the scientific basis of standard medical care for gender dysphoria.
In the report and in a public comment letter submitted to the Florida AHCA on July 8, the expert team states the following:
- The Florida report falsely claims that scientific evidence does not support medical treatment for gender dysphoria. In fact, the medical management of gender dysphoria is backed by solid scientific consensus. Medical care for gender dysphoria (sometimes called “gender affirming care”) has been used worldwide for decades, meets generally accepted medical standards, and is not experimental.
- The Florida report advocates a discriminatory policy that violates federal and state constitutions and federal and state laws. Florida’s AHCA offered the report to justify denying Medicaid coverage of medical care for gender dysphoria. But this discriminatory policy illegally targets transgender people. Neither the June 2 report nor the AHCA proposal would apply to similar treatments routinely offered to cisgender people.
- The Florida report repeatedly and wrongly dismisses strong medical research studies as “low quality,” demonstrating a poor understanding of statistics, medical regulation, and scientific research. The report makes unfounded criticisms of robust and well-regarded clinical research, while ignoring others. If Florida’s Medicaid program applied the June 2 report’s approach to all medical procedures equally, it would have to deny coverage for widely used drugs like statins (cholesterol-lowering drugs taken by millions of older Americans ) and common medical procedures like mammograms and routine surgeries.
- The Florida report cites sources that have no scientific basis. The report relies on pseudo-science, in particular on alleged biased and error-filled expert reports. The claimed reports are written by authors whose testimony has been disqualified in court and who have known ties to anti-LGBTQ advocacy groups. The report’s unsubstantiated claims come from unqualified sources, including a blog entry, letters to the editor, and opinion pieces.
“We are alarmed that the Florida Health Agency has adopted a purportedly scientific report that so flagrantly violates fundamental principles of scientific inquiry,” the report’s authors write. “The errors of the June 2 report are so repeated and fundamental that it seems clear that the report is not a serious scientific analysis but rather a document designed to serve a political agenda.”
The new report is the second analysis by a panel of independent interdisciplinary faculty experts to correct misinformation related to gender-affirming medical care – with a focus on publishing the real scientific evidence, which shows that standard care are safe, effective and save lives. In May, the authors published an analysis that refuted the unscientific claims behind gender-affirming healthcare lawsuits in Texas and Alabama.
The authors write that Florida’s actions are part of an alarming trend of attacking medically accepted gender-affirming care through state action. In 2021 and 2022 alone, Arkansas, Arizona, Alabama, Texas, and Florida passed legal measures that criminalize or restrict access to gender-affirming care for youth and adults. In all cases, proponents of these discriminatory laws have distorted and misused scientific information, the report says.
The report’s authors include Yale Law Professor Anne Alstott and Yale School of Medicine and Child Study Center faculty Meredithe McNamara, MD, MS; Susan D. Boulware, MD; Rebecca Kamody, PhD; Christy Olezeski, PhD; and Nathalie Szilagyi, MD. The author group also includes Laura Kuper PhD, University of Texas Southwestern and Hussein Abdul-Latif, MD, University of Alabama at Birmingham.
“Florida’s illegal attempt to deny transgender people standard medical care is the latest in a wave of anti-trans medical bans,” said Yale Law School professor Anne Alstott ’87, Professor Jacquin D. Bierman. “We were appalled that the state ignored real science and instead relied on biased and misleading evidence.”
Florida’s proposed denial of Medicaid benefits for gender-affirming care “discriminates against the poorest and most vulnerable segments of the population who have no other source of health care coverage. than Medicaid and lack the resources to venture out of state,” said Dr. Hussein Abdul-Latif, professor of pediatric endocrinology, University of Alabama at Birmingham.
The panel hopes their analysis will combat the misinformation about gender-affirming care that threatens to take hold in states across the country.
“As clinicians, we know all too well the distress and existential fears trans youth face in this hostile climate. Even our patients who don’t live in battleground states are seeing the emergence of these dangerous policies,” Dr. McNamara said. “They also look at us, the adults who take care of them. They want to see how we defend their right to a healthy and fulfilled adolescence.