Days before a state agency began researching whether transgender medical care for Floridians should be covered by Medicaid, officials started lining up experts known for going against the scientific mainstream.
The resulting report and state rule revoked Medicaid coverage of treatments for gender dysphoria such as puberty blockers and hormone therapy. It was thrown out by a federal judge, who in his June order called the rule an “exercise in politics, not good medicine.”
Hundreds of pages of state employee testimony and internal agency records gathered as part of the federal case show how closely the state coordinated with consultants who have taken stances counter to major medical organizations on how to treat gender dysphoria. Those consultants were paid tens of thousands by the state. One grew friendly enough with a top agency official that he took to calling him “mighty Jason” and “J-man” over text messages.
Court testimony from state employees also reveal how an agency under Gov. Ron DeSantis veered from its own procedures to compile a report centered on a topic that has become a major plank of the governor’s presidential campaign. The state employee who was the lead author of the report testified that the process began with a request from the governor’s office. He also testified that he had not seen another instance of the state using this type of report to reevaluate treatments already covered by Medicaid.
After the Medicaid report was completed, at least two Agency for Health Care Administration employees involved with it received raises well above the norm for their peers, state data show.
“It seemed like a very politically motivated effort to exclude a group of people from coverage,” said Jeff English, a former agency staffer.
Medical organizations support treatment
Major organizations, like the American Academy of Pediatrics, support medical interventions for gender dysphoria when developmentally appropriate.
English said it was usually his job to do the type of report that was produced. But not this time. He testified that agency officials assigned others to the task because his supervisor knew that English perceived this report as “a conclusion in search of an argument.”
“I took pride in producing fair, accurate, well-researched reports,” English told the Tampa Bay Times. “And that was not one of those.”
In response to emailed questions, Bailey Smith, a spokesperson for the agency, denied that it deviated from normal process when producing the report, including the selection of staffers to complete it.
“No one person has been solely responsible for all reports at the agency,” she said. “The fact is that the use of puberty blockers and cross-sex hormones has increased by more than 63% since 2017, in part because the U.S. is decades behind other developed nations on guidance for supposed ‘gender-affirming care.’ “
English said the way the state undermined its own processes in producing this report hurt morale within the agency, which along with other segments of Florida’s state government, has seen high turnover in recent years.
“When process and procedure start falling by the wayside, that contributes to low morale because people [begin] … questioning the way things are being done,” English said.
Consultants were ‘part of the team’
In the June ruling, U.S. District Judge Robert Hinkle wrote that the report was, “from the outset, a biased effort to justify a predetermined outcome, not a fair analysis of the evidence.” Hinkle is a judge in the Northern District of Florida and was appointed by former President Bill Clinton. He’s the same judge who declared that DeSantis was wrong to remove Hillsborough State Attorney Andrew Warren but that he couldn’t give him his job back because he lacked jurisdiction.
In the Medicaid case, Hinkle cited other inconsistencies in the state agency’s process. Officials typically only prepared this type of report when considering a new treatment for Medicaid coverage, “but here, apparently for the first time ever,” the agency prepared a report on already-approved treatments, Hinkle wrote. And they brought in experts, he noted, who were “known in advance for their staunch opposition to gender-affirming care.”
The state has appealed Hinkle’s ruling. In his deposition, the report’s lead author, Matt Brackett, said the agency relied on consultants because they were expecting litigation and needed as “robust a report as possible.”
The state contracted with seven consultants for up to about $322,000, records show, and has disbursed at least $93,000.
Romina Brignardello-Peterson, a Canadian researcher, has collected $34,800, according to a state payment database, making her the highest paid consultant so far. Brignardello-Peterson previously did work for for the Society for Evidence Based Gender Medicine. A group of scientists from Yale University, in a public response critiquing Florida’s report, called that society an “activist group that opposes standard medical care for gender dysphoria.”
At least $15,900 was paid to Andre Van Mol, a California physician and prominent member of the conservative American College of Pediatricians, an organization designed as an alternative to the mainstream American Academy of Pediatrics. The group’s beliefs include that kids are worse-off when raised by same-sex couples and that gay youth can “return” to being heterosexual with counseling, according to a page on its website.
The state also paid at least $12,400 to Quentin Van Meter, an Atlanta child endocrinologist who was previously the president of the conservative pediatricians group, state records show.
Consultants have been frequent speakers on the issue
The consultants retained by Florida have traveled around the country speaking in courtrooms and legislatures to push back against issues surrounding transgender rights across the nation, including in Ohio, Arkansas and Alabama.
A judge in Texas previously found Van Meter to be “discredited as an expert” on hormone treatment, according to the Pennsylvania Capital-Star, a nonprofit news outlet that’s part of a national network covering state governments. (Van Meter also testified in the Pennsylvania House on the topic of transgender medical care.)
The other consultants are Miriam Grossman, a New York child psychiatrist whose website states that she “believes every child is born in the right body;” Patrick Lappert, an Alabama plastic surgeon and Catholic deacon who has said the transgender view of identity is an attack on fundamental Christian concepts; James Cantor, a Canadian psychologist and sex researcher who has written a contrary response to the American Academy of Pediatrics policy supporting medical care for gender dysphoria, and Gerard Kevin Donovan, a Georgetown bioethicist who has written that “present day denigrations” started with birth-control pills.
Most of the consultants did not respond to questions sent by email or declined to comment. Cantor, in an email, said he is not biased against gender-affirming care — in fact, he has supported public funding for medical transition for adults, he said.
“I have no ideological opposition to the medicalized transition of minors, but as the systematic reviews have all concluded, the evidence does not support the easy access that many want,” he wrote.
Polarizing topic and opinions
Cantor also disagreed with the notion that the Florida report was driven by politics.
“Given the enormously polarized views on the topic, any conclusion seeming to favor either side will be denounced as political by the other,” Cantor stated. “In the present context, I cannot imagine anyone whom all sides would accept as neutral and objective.”
Brignardello-Petersen said that she has “never expressed opinions regarding gender-affirming care, neither in the report or elsewhere.”
“As an expert in assessing and synthesizing evidence, the Florida Agency for Health Care Administration asked me, as a consultant, to provide professional assessments of the published scientific evidence using best practice methodology,” she wrote.
An agency leader also sought people to speak against medical transition and was willing to pay a consultant to find them. Jason Weida, who is now the agency’s secretary, asked a consultant to recruit Floridians who regretted gender-affirming treatment or doctors who turned against the practice, text messages show.
Some of the consultants also appeared at a hearing in July 2022 about the Medicaid exclusion and pushed back when members of the public criticized the state’s report. Multiple consultants at the hearing billed taxpayers thousands for their time.
Both before and after the hearing, Van Mol and Weida appeared friendly over text messages, with Van Mol referring to Weida as “mighty Jason” and “J-man.”
While state employees were compiling the Medicaid report, Van Mol emailed Weida articles theorizing about the “financiers” of the “trans movement,” arguing that it was connected to pharmaceutical companies.
The two kept in touch after the Medicaid rule went into effect and as litigation over the rule continued. In November, Van Mol texted Weida to tell him that it was a “downer” not to have testified before the Board of Medicine — which prohibited medical treatment for gender dysphoria for children — but said it was “very wise of you and therefore the board to have taken my advice” to have specialists speak.
“Being part of the team pushing forward with the right cause is what counts, not polishing my ego. :),” Van Mol said in a text.
Award for state workers who wrote report
Following the release of the report, Weida presented the state employees who wrote it with an “award of excellence” at an internal agency ceremony in June, photos posted on LinkedIn show.
When asked about the text messages between Van Mol and Weida as well as the awards ceremony photos, Smith, the health care agency spokesperson, alleged that the Times had seen both by “online stalking.” Screenshots of the text messages were included in court documents as part of the federal trial, while the LinkedIn photos were posted publicly.
Public salary data show that at least two of the staffers involved with implementing that controversial recommendation received raises well beyond the norm.
Cole Giering, a program administrator at the agency, made $20,000 more as of June 2023 than he did with the same job title at the beginning of last year. His 33% raise in the span of 18 months is about five times higher than the average for employees who held the same job, according to a state database analyzed by the Times.
A senior pharmacist involved in compiling the report, Nai Chen, received a raise of about $13,000 in the same period, a 13% bump. Other senior pharmacists who were not part of the report received raises just over 5%, the salary database shows.
When asked about the differences in pay, Smith said the agency “provides merit-based pay raises to retain employees.” None of the individual employees responded to emails requesting comment.
Several other staffers involved in the report, including Brackett, are not listed in the salary database, and the agency has not provided their pay information.
‘A major deviation’
Scott Rivkees, who led the Florida Department of Health from 2019 to until 2021, said that typically the “delicate and sensitive” issue of how to treat gender dysphoria has been left to the patient, their family and their doctors.
States such as Florida that are intervening mark “a major deviation from how medicine is typically practiced,” Rivkees said in an interview.
The Medicaid report isn’t the first time in DeSantis’ administration that the process for providing guidance on certain healthcare topics appears to have been influenced by political considerations. In April, the Tampa Bay Times reported that Florida health officials removed key data from a report on the safety of COVID-19 vaccines that undermined their recommendation against young men getting the vaccines.
Brackett, the lead author of the Medicaid report, testified that it was a “first” for the agency to develop a slogan for the type of report they produced — the agency titled the final package of research “Let Kids Be Kids.”
Nearly a year later, DeSantis would sign a sweeping package of bills criticized for targeting the LGBTQ+ community, including a bill prohibiting puberty blockers and hormone therapy for gender dysphoric children, under the same title.
In an email after Florida’s rule hearing, one of the consultants, Grossman, wrote that she loved how the audience cheered each time DeSantis was mentioned.
“To which state do we go next?” Grossman wrote to some of the other consultants and to Weida. “I’m ready.”