Mississippi Today
Mississippi Medicaid: Gender-affirming care for kids is not ‘safe and effective’
Mississippi Medicaid: Gender-affirming care for kids is not ‘safe and effective’
The Mississippi Division of Medicaid is the first state agency to take a public position on gender affirming care to transgender children, stating there is not enough medical literature to support that it is a “safe and effective treatment for gender dysphoria.”
In a letter to managed care companies that contract with Medicaid, Executive Director Drew Snyder wrote that the agency concurs with its counterpart in Florida that there is not enough evidence that “sex reassignment through medical intervention” is safe. Florida’s report was released in June of last year.
Snyder did not respond to a call and text to his personal cell phone Thursday afternoon. His letter was addressed to executives of Molina Healthcare of Mississippi, UnitedHealthCare Community & State MS and Magnolia Health Plan. Communications officials with the three companies did not immediately respond to requests for comment.
“As the care coordination organizations for the majority of children and adolescents enrolled in Mississippi Medicaid, your input is welcome on approaches to effectively address any health needs without posing risky side effects or irreversible changes,” he wrote.
It’s unclear if Snyder’s letter has any effect on what services are currently covered, or why he reached out to the managed care companies instead of providers of gender-affirming care. If the agency does opt to exclude this treatment, it would join a handful of states already doing so. Alaska, Arizona, Arkansas, Florida, Kentucky, Missouri, Nebraska, Ohio, Tennessee and Texas all have Medicaid policies that specifically exclude transgender health coverage, according to the Movement Advancement Project.
The Feb. 15 letter first reported by the Magnolia Tribune comes as a bill is working its way through the Legislature that would ban this kind of treatment for trans minors in Mississippi. House Bill 1125 would prevent the state’s roughly 2,400 trans kids and their families from getting hormone therapy or puberty blockers in the state.
Snyder’s letter contradicts the advice and position of major medical associations in the U.S. on gender-affirming care. It is evidence-based, and not considered “experimental” by the majority of the medical community.
Also known as the “Regulate Experimental Adolescent Procedures” (REAP) Act, the bill bans Mississippi doctors from performing gender-confirmation surgery or prescribing drugs such as puberty blockers or hormones to those under 18.
The bill would allow for the doctors’ licenses to be revoked and create a “civil claim of action” for them to be sued with a 30-year statute of limitations. It would prohibit insurers or Medicaid from reimbursing families for such procedures and would strip doctors who provide them of the state’s generous tort claims protections.
READ MORE: What to know about gender-affirming care in Mississippi
Gender-affirming care, or “sex reassignment” as Mississippi officials have called it, refers to a broad range of interventions, from medical treatment to psychological and social support, that aims to affirm an individual’s gender identity, especially when it is different from the one they were assigned at birth, according to the World Health Organization.
Decades of research support gender-affirming care as the proper treatment for gender dysphoria, the distress trans people can experience when their physical features do not match their gender identity.
Research has repeatedly shown that gender-affirming care significantly boosts the chances that trans kids will live to see adulthood. A study published last year in the peer-reviewed Journal of the American Medical Association found that over the course of a year, gender-affirming care was associated with 60% reduced odds of moderate to severe depression and 73% less odds of suicidal thoughts.
Stacie Pace, the co-owner of Spectrum: The Other Clinic, said that the two main international medical organizations that write guidelines for gender-affirming care — the World Professional Association for Transgender Health and the Endocrine Society — cite hundreds of references and are easy to find on the internet.
“All it takes is just a quick Google, and all this research is right there in front of you,” she said.
There are three main forms of gender-affirming medical treatment: Puberty blockers, which are only for kids, hormone therapy and gender-confirmation surgery. In Mississippi, there is no clinic that performs any kind of gender-confirmation surgery on minors, according to in-state providers of gender-affirming care.
Puberty blockers are medications that pause puberty in kids. Research has shown the effects are reversible. While hormone therapy can cause some permanent effects, such as a deeper voice, it typically takes at least a year for this to occur, Pace said.
But Pace added that many other side effects of hormone therapy, like increased muscle mass or the development of breast tissue, will disappear over time if a patient ceases treatment.
“It will take about as long as it took for it to occur, but it will go away,” she said.
Alex Mills, a pharmacist who has worked with trans people, said he was confused by the letter. While a minority of his patients are on Medicaid, he hasn’t heard of Medicaid covering prescriptions for hormone therapy for trans adults since he started working in Jackson three years ago. If Medicaid covered prescriptions for his outspoken patients, Mills said they would tell him.
“I feel like they’re just kind of jumping on the bandwagon,” he said. “It’s an irrelevant comment, because they (Medicaid) haven’t been covering (hormone therapy), so I’m just confused why they’re even saying this. Just to say it?”
Mills said Medicaid has covered medical visits, but that he doesn’t know if it has covered puberty blockers, which can be pricey – up to $1,500 for a single shot that lasts a month. Hormone therapy is cheaper, so Mills recommends patients use GoodRx coupons to make their prescriptions more affordable.
At Spectrum, Pace said just one youth patient is currently on Medicaid. But of the clinic’s roughly 1,000 adult patients, about half are Medicaid beneficiaries.
The Division of Medicaid has not taken a stance on other issues being considered by the Legislature. One of those is extending postpartum care from 60 days to one year for new mothers, which Speaker of the House Philip Gunn said he has asked the agency to do.
When a committee tasked with advising Medicaid about health and medical care services voted unanimously in October to recommend that the Legislature extend postpartum coverage, the Division of Medicaid still did not take a stance.
The State Board of Medical Licensure, which would enforce the bill’s provision revoking providers’ licenses, has not responded to questions from Mississippi Today. The University of Mississippi Medical Center, which has provided gender-affirming care to trans kids at its LGBTQ-focused TEAM Clinic, said earlier this month that “we have no comment for now.”
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
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Mississippi Today
On this day in 1997
Dec. 22, 1997
The Mississippi Supreme Court upheld the conviction of white supremacist Byron De La Beckwith for the 1963 murder of Medgar Evers.
In the court’s 4–2 decision, Justice Mike Mills praised efforts “to squeeze justice out of the harm caused by a furtive explosion which erupted from dark bushes on a June night in Jackson, Mississippi.”
He wrote that Beckwith’s constitutional right to a speedy trial had not been denied. His “complicity with the Sovereignty Commission’s involvement in the prior trials contributed to the delay.”
The decision did more than ensure that Beckwith would stay behind bars. The conviction helped clear the way for other prosecutions of unpunished killings from the Civil Rights Era.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
Medicaid expansion tracker approaches $1 billion loss for Mississippi
About the time people ring in the new year next week, the digital tracker on Mississippi Today’s homepage tabulating the amount of money the state is losing by not expanding Medicaid will hit $1 billion.
The state has lost $1 billion not since the start of the quickly departing 2024 but since the beginning of the state’s fiscal year on July 1.
Some who oppose Medicaid expansion say the digital tracker is flawed.
During an October news conference, when state Auditor Shad White unveiled details of his $2 million study seeking ways to cut state government spending, he said he did not look at Medicaid expansion as a method to save money or grow state revenue.
“I think that (Mississippi Today) calculator is wrong,” White said. “… I don’t think that takes into account how many people are going to be moved off the federal health care exchange where their health care is paid for fully by the federal government and moved onto Medicaid.”
White is not the only Mississippi politician who has expressed concern that if Medicaid expansion were enacted, thousands of people would lose their insurance on the exchange and be forced to enroll in Medicaid for health care coverage.
Mississippi Today’s projections used for the tracker are based on studies conducted by the Institutions of Higher Learning University Research Center. Granted, there are a lot of variables in the study that are inexact. It is impossible to say, for example, how many people will get sick and need health care, thus increasing the cost of Medicaid expansion. But is reasonable that the projections of the University Research Center are in the ballpark of being accurate and close to other studies conducted by health care experts.
White and others are correct that Mississippi Today’s calculator does not take into account money flowing into the state for people covered on the health care exchange. But that money does not go to the state; it goes to insurance companies that, granted, use that money to reimburse Mississippians for providing health care. But at least a portion of the money goes to out-of-state insurance companies as profits.
Both Medicaid expansion and the health care exchange are part of the Affordable Care Act. Under Medicaid expansion people earning up to $20,120 annually can sign up for Medicaid and the federal government will pay the bulk of the cost. Mississippi is one of 10 states that have not opted into Medicaid expansion.
People making more than $14,580 annually can garner private insurance through the health insurance exchanges, and people below certain income levels can receive help from the federal government in paying for that coverage.
During the COVID-19 pandemic, legislation championed and signed into law by President Joe Biden significantly increased the federal subsidies provided to people receiving insurance on the exchange. Those increased subsidies led to many Mississippians — desperate for health care — turning to the exchange for help.
White, state Insurance Commissioner Mike Chaney, Gov. Tate Reeves and others have expressed concern that those people would lose their private health insurance and be forced to sign up for Medicaid if lawmakers vote to expand Medicaid.
They are correct.
But they do not mention that the enhanced benefits authored by the Biden administration are scheduled to expire in December 2025 unless they are reenacted by Congress. The incoming Donald Trump administration has given no indication it will continue the enhanced subsidies.
As a matter of fact, the Trump administration, led by billionaire Elon Musk, is looking for ways to cut federal spending.
Some have speculated that Medicaid expansion also could be on Musk’s chopping block.
That is possible. But remember congressional action is required to continue the enhanced subsidies. On the flip side, congressional action would most likely be required to end or cut Medicaid expansion.
Would the multiple U.S. senators and House members in the red states that have expanded Medicaid vote to end a program that is providing health care to thousands of their constituents?
If Congress does not continue Biden’s enhanced subsidies, the rates for Mississippians on the exchange will increase on average about $500 per year, according to a study by KFF, a national health advocacy nonprofit. If that occurs, it is likely that many of the 280,000 Mississippians on the exchange will drop their coverage.
The result will be that Mississippi’s rate of uninsured — already one of the highest in the nation – will rise further, putting additional pressure on hospitals and other providers who will be treating patients who have no ability to pay.
In the meantime, the Mississippi Today counter that tracks the amount of money Mississippi is losing by not expanding Medicaid keeps ticking up.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
On this day in 1911
Dec. 21, 1911
Josh Gibson, the Negro League’s “Home Run King,” was born in Buena Vista, Georgia.
When the family’s farm suffered, they moved to Pittsburgh, and Gibson tried baseball at age 16. He eventually played for a semi-pro team in Pittsburgh and became known for his towering home runs.
He was watching the Homestead Grays play on July 25, 1930, when the catcher injured his hand. Team members called for Gibson, sitting in the stands, to join them. He was such a talented catcher that base runners were more reluctant to steal. He hit the baseball so hard and so far (580 feet once at Yankee Stadium) that he became the second-highest paid player in the Negro Leagues behind Satchel Paige, with both of them entering the National Baseball Hame of Fame.
The Hall estimated that Gibson hit nearly 800 homers in his 17-year career and had a lifetime batting average of .359. Gibson was portrayed in the 1996 TV movie, “Soul of the Game,” by Mykelti Williamson. Blair Underwood played Jackie Robinson, Delroy Lindo portrayed Satchel Paige, and Harvey Williams played “Cat” Mays, the father of the legendary Willie Mays.
Gibson has now been honored with a statue outside the Washington Nationals’ ballpark.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
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