Trans residents sue Florida over gender-affirming Medicare ban

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When August Dekker celebrated his twenty eighth birthday in June, it was a moment of affirmation and euphoria, he said.

The Hernando County, Fla., resident went to the beach together with his family. It was an ideal afternoon, he said: They sipped mojitos, played within the water, made “a really bad sand castle,” and ate mac and cheese at a seaside restaurant. However the highlight of the day was an easy one — it was the primary time he could take his shirt off in public and feel comfortable.

Dekker, who’s transgender, had undergone chest surgery three months before.

Although Dekker had been taking testosterone injections for years, he said he decided to get top surgery due to the shifting political and social climate — as more states, including Florida, attempt to roll back access to gender-affirming care.

“I used to be afraid that if I didn’t get the ball rolling, that I might not have the ability to have surgery covered in the longer term,” he said. Because Dekker receives disability advantages — they’re his only source of income — he was in a position to pay for the procedure through Medicaid, just as he has done for his hormone therapy.

But in accordance with a rule approved by Florida health officials last month, Dekker and other trans patients now not can use Medicaid to pay for his or her gender-affirming care.

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Dekker and three other trans Floridians are fighting back against the policy.

On Wednesday morning, LGBTQ and health advocacy groups filed a lawsuit within the U.S. District Court for the Northern District of Florida difficult the state’s recent Medicaid exclusion. The grievance was filed on behalf of Dekker and Brit Rothstein, in addition to two minors, Susan Doe (represented by parents John and Jane Doe) and K.F. (represented by mother Jade Ladue). The lawsuit argues that Florida’s policy, which went into effect last month, violates the plaintiffs’ constitutional rights and federal nondiscrimination statutes, since it categorically denies them treatment on the idea of their gender identity.

Brock Juarez, a spokesperson for the Agency for Health Care Administration, which is called within the lawsuit, defended the policy.

“Under our rules, only treatments which are found to be secure, effective, and that meet medical necessity criteria could also be covered,” Juarez wrote in an email. “That’s precisely what the Agency has done here.”

The state’s Medicaid exclusion occurs amid a bigger effort, in Florida and elsewhere, to roll back access to gender transition care, particularly for trans youths. Conservative lawmakers argue that these policies are supposed to protect children and families from harmful procedures they could later regret.

Gender-affirming care is “critical and lifesaving” for transgender Floridians, said Simone Chriss, the director of the Transgender Rights Initiative on the Southern Legal Counsel, certainly one of the groups involved within the lawsuit.

“It’s essential that we dispel the myths that allow people to consider that bans like this are protecting anyone,” Chriss said. “They’re harming people and denying them access to care that has been deemed medically obligatory for them.”

Omar Gonzalez-Pagan of Lambda Legal, an LGBTQ civil rights organization also difficult the rule, added that the procedures banned for trans patients are still covered for cisgender Medicaid patients using them to treat other conditions.

Across the country, advocacy groups are pushing back against such policies. In Alabama and Arkansas, bans on gender-affirming care have been temporarily blocked by federal courts amid legal challenges.

Gender-affirming care can, but doesn’t all the time, include medical interventions corresponding to hormone substitute therapy, chest surgery or voice therapy. Although conservative politicians — including Florida Gov. Ron DeSantis (R) — often consult with genital surgeries being performed on minors, these procedures usually are not beneficial for patients younger than 18.

While just over half of states have expanded Medicaid protections for gender-affirming care, Florida is amongst nine states that explicitly exclude residents from using Medicaid to pay for it.

The rule got here after a report in June by the state’s Agency for Health Care Administration that claims services for the treatment of gender dysphoria are “not consistent with widely accepted skilled medical standards,” and are “experimental and investigational with the potential for harmful long run affects.”

Medical professionals told The Washington Post last month that the agency’s actions are highly unusual and concerning.

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The country’s largest medical organizations, including the American Academy of Pediatrics, recommend gender-affirming care to assist treat minors experiencing psychological distress because their biological sex and gender identity don’t align, a condition referred to as gender dysphoria. In April, 300 medical providers within the state wrote an open letter within the Tampa Bay Times criticizing a state memo that advised doctors not to provide gender-affirming care to minors.

“Florida was really the primary state to come back for the throat of the medical evidence behind gender-affirming care, to create this false narrative that there will not be sufficient evidence to support the advantages,” said Meredithe McNamara, an assistant professor at Yale’s School of Medicine who was a component of a team of researchers that recently reviewed the AHCA report.

Brock Juarez, a spokesperson for the AHCA, told The Washington Post in August that the agency conducted “a really thorough process, and our in-depth work and findings really speak for itself.”

Because the state’s medical board considers more rules restricting trans Floridians’ ability to receive gender-affirming care, patients who depend on Medicaid are scrambling to work out how they’ll pay for his or her upcoming treatments and never disrupt the care on which they’ve come to depend.

Amongst those exploring alternative funding are John and Jane Doe, who joined the lawsuit on behalf of their 12-year-old daughter, “Susan.” The couple, who declined to be named to guard their child’s right to privacy, adopted Susan, in addition to their eldest son, out of medical foster care, which makes the youngsters eligible for Medicaid coverage until they turn 18.

As a young child, Susan would come home from school and immediately change into “princess dresses,” in accordance with the lawsuit. Eventually, she socially transitioned — changing her name, hair and pronouns to align together with her gender identity.

Along the way in which, the family began working with a team of doctors — including mental health specialists, primary-care physicians and a pediatric endocrinologist — to support Susan’s medical needs. On their advice, she recently began taking Lupron, a puberty blocker that should be administered every three months.

In accordance with the grievance, her next injection is scheduled for October, but without Medicaid coverage, the family could also be forced to pay out of pocket for the medication, which they said costs about $11,000 for a single shot.

They’d should go into debt to afford Susan’s care, even when they can move her under her father’s health-care plan. Switching insurance policy also signifies that Susan may very well be cut off from her long-term health-care providers, including those seeing her for other conditions.

It’s a “cruel” position to be put in, Susan’s father said in an interview.

Dekker, the trans man receiving disability advantages, said he fears for his safety in a way he had not before.

The political attacks have triggered increased harassment and violence against trans people in Florida, he said. But Dekker also remembers what it felt prefer to be without hormone therapy. He was depressed and reclusive, showering with the lights off so he wouldn’t should see his body, he said. At times, he was suicidal.

That’s why it was essential to him to step forward and challenge his home state, Dekker said: “The considered going back to that ghost individual that I used to be. … I don’t need to develop into that person again.”

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