On Friday, August 5, the Florida Board of Medicine ignored warnings from medical professionals and parents of transgender children and voted to adopt a “standard of care” that opposes gender-affirming care for transgender youth. healthcare workers at risk of providing life-saving care. This vote does not immediately place limits on gender-affirming care, but begins the regulatory process to do so.
It’s the latest in a coordinated attack on the health needs of transgender youth and adolescents. Below is an explanation of what happened in Florida, what might happen next, and what steps Florida residents can take to protect trans children, their families, and their health care providers.
What did the Florida State Board of Medicine vote to do?
The Florida State Board of Medicine (BOM) is responsible for setting standards of care for all medical providers in Florida and ensuring their compliance with licensing and disciplinary review. Changing the standard of care requires (at a minimum) a formal rulemaking process under the Florida Administrative Procedure Act. On Friday, Aug. 5, the board officially began the formal rulemaking process, which takes up to 180 days and requires at least 90 days to complete, to review proposed rules limiting medically necessary care to transgender youth. The proposed changes to state standards of care would do two things:
- Threaten doctors with penalties or fines if they provide gender-affirming care to anyone under 18, such as treating gender dysphoria.
- Establish waiting periods for adults seeking gender-affirming care and require adults to sign an informed consent form that contains misinformation about the risks of gender-affirming care.
What is gender-affirming care?
According to the US Department of Health and Human Services, “Gender-affirming care is a supportive form of health care. It consists of a range of services for transgender and non-binary people, which may include medical, surgical, mental health and non-medical services. Early gender-affirming care for transgender and non-binary children and adolescents is critical to overall health and well-being because it allows the child or adolescent to focus on social transitions and can increase their confidence as they navigate the health care system.”
Gender-affirming care is a highly personalized form of health care and looks different for each person, depending on their age, gender, and other physical and mental health needs. For pre-teen transgender youth, this care usually involves “social transition” (changing clothes, hair, name, etc.) and never involving surgery or other irreversible medical treatments. During or after puberty, many transgender youth may receive reversible puberty blockers, hormone replacement therapy, or other medical interventions under the supervision and prescription of medical professionals. Some older transgender teens can and do seek surgical treatment on a case-by-case basis, as recommended by the World Association of Transgender Health Professionals.
Gender-affirming care is widely recognized as the only evidence-based approach to addressing the health needs of transgender youth, including serious mental health risks. More details:
The medical community is already highly critical of Florida’s ongoing efforts to ban gender-affirming care. In June, the Agency for Health Care Administration, which oversees Florida’s Medicaid program, released a report claiming that national standards of care for gender dysphoria conflict with nationally accepted standards for Medicaid coverage. Medical and legal experts quickly condemned the proposed rules as “thoroughly flawed and lacking scientific weight.” In April, the Florida Department of Health (DOH) released a memo recommending against gender-affirming care for children and adolescents. Citing the surgeon general’s memo to justify these restrictions, the researchers accused him of misrepresenting their work and condemned the proposed restrictions.
Three hundred Florida health care providers who work with transgender youth subsequently published an open letter in the Tampa Bay Times condemning the proposed regulations. The governor and surgeon general’s directive, experts write, “misrepresents the weight of evidence, fails to allow for individualized patient- and family-centered care, and, if followed, will lead to higher rates of depression and suicide among young people.”
Similar bans signed in Arkansas and Alabama are both being blocked by federal courts.
What will happen next?
The Florida State Medical Board’s vote was prompted by a “petition to initiate rulemaking” submitted to the board by the DOH at the direction of Surgeon General Joseph Ladapo, who heads the DOH. The move came at the behest of Governor Ron DeSantis, who appointed members of the MB and has long pushed a broader extremist and anti-trans political agenda.
Now that the board has begun rulemaking, they will work internally to draft the proposed regulation, submit it for formal review, comment and public hearings, and eventually issue a final rule. They must accept public comments for 21 days after publishing their proposed regulations, then hold a public hearing. After the hearing, they must wait at least 14 days to publish the final version of the regulation. The final rule takes effect 20 days after publication.
If the council does indeed finalize the regulation to ban gender-affirming care for minors (or something more expansive), it will likely go into effect in October or November 2022.
How will this regulation affect gender-affirming care providers in Florida?
If the final regulation is adopted and goes into effect (and not ordered by a court), it means that any provider who continues to provide this care to minors will be subject to professional discipline by the BOM. Disciplinary proceedings may be initiated based on a public complaint and directly by the staff of the surgeon general. This discipline may result in suspension or revocation of medical licenses.
It is likely that all providers will voluntarily stop providing such care, that health insurance plans will actively end its coverage, and that wrongful insurers will impose higher premiums on providers who confirm their gender even if they are not caring for minors or others, or means it will reduce the scope. the population covered by the ban.
What can I do to stop this and ensure Floridians have access to gender-affirming care?
After the BOM publishes its proposed rule to change the standard of care to prohibit gender-affirming care for minors, the board will be required to accept written comments from the public within 21 days of the proposed rule’s publication in the Florida Administrative Office. Sign up. After the 21 days are up, a public hearing will be held by the board. Comments submitted by the public by e-mail or written letter will be included in the official minutes of the BOM proceedings.
The number of people who can speak at public hearings may be limited and, although governed by the BOM, members of the public may also attend public hearings. During public hearings on Medicaid rule changes in July 2022, the Health Administration Agency filled its speaker slots with speakers who were mostly hostile to gender-affirming care. If the BOM takes the same approach, it may be difficult or futile to attempt public comment at the hearing.
One of the most important things you can do is register to vote before the Oct. 11 registration deadline and help elect lawmakers who will work to protect the rights of transgender youth, their families, and their health care providers.
In addition to participating in the rulemaking process, you can make a difference by getting to know your neighbors and being part of your local community. Gender-affirming care is not well understood by the public, and hostile groups spread misinformation to scare and misinform people about gender-affirming care and the transgender community. Being visible and participating in the local community can help the public understand that gender-affirming care is not a threat to society and should be allowed like any other medical care.