Five Medicaid healthcare insurers have violated Florida’s rule against using taxpayer funds to provide transgender treatments, and the state is now fining them for the action. It’s the first time any state has taken this step in regard to gender transition coverage.
Among the procedures one of the plans covered was a double mastectomy on a 16-year-old girl. The other plans paid for puberty blockers and cross-sex hormones for minors. Florida health officials sent out letters informing the providers they were being fined over the violation late Thursday.
“These plans recklessly continued to cover these services with permanent, harmful effects, after the rule was adopted,” Jason Weida, Secretary of the Agency for Healthcare Administration, told The Daily Wire news podcast Morning Wire. “[They] will not stand in the way of our fight to protect the innocence of Florida’s kids.”
Though a federal judge recently blocked a new law in Florida that banned transgender surgeries and medications for children, a rule from the Agency for Health Care Administration still required the state’s Medicaid plan providers to deny coverage for all such treatments.
The rule went into effect last August after the agency performed a systematic review of the medical literature on treatments for gender dysphoria in children, including surgeries, puberty blockers, and cross-sex hormones. It determined they are not medically necessary. But in December, well after the agency says Medicaid healthcare plan providers were notified of the rule, the five providers covered the trans treatments anyway. The violations were caught as part of a routine audit of the Medicaid system.
Typically, Medicaid rule violations occur when providers refuse to pay for treatment that should have been covered. Paying for procedures and medications that have been banned is extremely unusual, raising the question of whether the providers’ decisions to provide coverage were politically motivated. Weida told The Daily Wire he doesn’t want to speculate about their reasons but “they’re certainly going to be on notice now.” He added that his office would consider more drastic penalties for any further violations.
Simply Healthcare, the provider that covered the mastectomy, is facing a $30,000 penalty and will be sanctioned. The other providers face smaller, unspecified fines, but the non-willful sanction is the more serious penalty as it places a black mark on a provider’s record that must be disclosed when it competes for contracts. Providers who have been sanctioned are much less likely to be awarded other state contracts for 10 years until the sanction expires. According to the Agency for Health Care Administration, Simply Health has already replaced the team that approved the mastectomy coverage.
Weida told The Daily Wire that he’s grateful Governor Ron DeSantis empowered his office to issue the rule blocking public money from going to transgender surgeries, and he doesn’t see it as a question of politics but of ethics.
“We take this issue really seriously,” he said. “We think that the protection of children is one of the most core functions of government here in Florida, and we’re going to do everything we can to protect children from these surgeries, which are really mutilating children across the country.”
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