A federal judge rejects the state’s request to evaluate kids in transgender Medicaid fight

A federal judge has rejected a request by Gov. Ron DeSantis’ administration to conduct “mental examinations” on a pair of 12-year-olds who are plaintiffs in a challenge to a state rule prohibiting Medicaid coverage for gender-affirming care.

U.S. District Judge Robert Hinkle’s two-page decision, released Wednesday, came after lawyers for the Florida Agency for Health Care Administration, which largely oversees the Medicaid program, filed a motion asking him to order evaluations of plaintiffs identified as “Susan Doe” and “K.F.”

Dr. Geeta Nangia, a South Carolina-based psychiatrist selected by the state to conduct the exams, in court documents challenged the use of medical interventions for children and adolescents seeking trans care, calling such treatment “risky at best” and supporting the state’s stance.

Hinkle's decision noted that the state’s motion identified Nangia’s qualifications as a psychiatrist who treats children and adolescents, but he said it “does not address her experience treating transgender” youths.

“Her expert report --- not mentioned in the motion --- says she has treated over a thousand patients with gender dysphoria. But the report does not indicate how many of those patients, if any, she supported in their identified gender,” Hinkle’s decision said.

The judge also pointed to a Nov. 15 scheduling order in which he said that, under court rules, the plaintiffs could have to undergo “appropriate examinations … but no individual will be required to submit to an examination by a transgender denier or skeptic.”

“Because the current motion does not address whether Dr. Nangia is a transgender denier or skeptic, this order denies the motion,” Hinkle wrote. “Any renewed motion should address how many patients Dr. Nangia has supported in their identified gender. Any renewed motion should also address how any finding from an examination might affect a ruling on the controlling substantive issue of whether treatments at issue are experimental.”

The DeSantis administration last summer approved a rule to stop Medicaid payments to medical providers for such treatments as puberty blockers, hormone therapy and gender-reassignment surgery. The costs of such surgeries, services and medications can run to thousands of dollars per month.

Four transgender plaintiffs, including Susan Doe and K.F., filed a federal lawsuit challenging the rule, alleging treatment of gender dysphoria is “medically necessary, safe and effective.”

In the lawsuit, parents of the children diagnosed with gender dysphoria expressed concern that the changes to the Medicaid program would have a negative effect on their children’s mental health and could even lead to attempted suicide. The federal government defines gender dysphoria as clinically “significant distress that a person may feel when sex or gender assigned at birth is not the same as their identity.”

But in a motion filed Tuesday, the state’s lawyers argued Nangia needed to examine the children.

“Defendants are entitled to confirm whether or not plaintiffs suffer from gender dysphoria. Defendants also are entitled to explore whether plaintiffs have undergone appropriate mental health treatment. And defendants are entitled to explore whether comorbidities, such as depression and anxiety, may be the root cause of plaintiffs’ emotional distress, and whether reversal of their gender affirming treatment will negatively impact their mental health as alleged,” Mohammad Jazil, the state’s lead lawyer on the case, argued.

AHCA has approved a $950,000 contract with Jazil’s firm --- Holtzman Vogel Baran Torchinsky & Josefiak PLLC --- to represent the state in the dispute over the Medicaid rule. The firm also received more than $20,000 in separate contracts for legal research on the rule as it was being developed and approved last year. The state has paid the firm more than $180,000 thus far, according to state records.

The rule went into effect in August, and Hinkle refused in October to issue a preliminary injunction to block it.

The state's motion this week said the psychological evaluations of the 12-year-olds would consist of an initial interview that would last about two hours; a “comprehensive psychiatric evaluation” to address gender dysphoria that would include “psychiatric history, developmental history, medical history, family history, social history;” and, among other things, discussion of “familial stability” and “peer groups.”

Nangia is CEO of Known and Loved, a Greenville, S.C.-based Christian organization focusing on children who have been in foster or adoptive care.

The organization’s website said Nangia “has a passion for walking children and families through a journey toward stronger and healthier relationships … and for building children’s self concept by helping them understand that they are indeed ‘fearfully and wonderfully made’ by God.”

The plaintiffs’ lawyers opposed the state’s request for the examinations.

Yale School of Medicine professor Meredithe McNamara praised Hinkle's decision to deny the evaluations.

“It’s heartening to know that the judge will not compel transgender youth to subject themselves to a traumatizing and unnecessary assessment as of now, but it never should have been requested in the first place. The state is wasting its resources to weaponize mental health and bully families,” she said in an email.

An Oct. 3 declaration by Nangia, filed in court documents, laid out her skepticism about gender-affirming treatment for youths.

Nangia said she has seen a “dramatic increase” in the number of children and adolescents who experience gender dysphoria or identify as transgender over the past decade.

“Important questions regarding the increased prevalence of gender dysphoria or transgenderism among youth must be raised,” she argued, blaming the increase in part on a “bandwagon effect.”

But psychiatrist Dan Karasik, one of the plaintiffs’ experts, picked apart Nangia’s record in a rebuttal, calling the number of patients she claimed to have treated as “highly suspect” and disputing her allegations that trans patients regretted gender-affirming treatment.

Karasik also attributed the increase in the number of transgender youths to changes in how data is collected.

Nangia’s declaration, however, argued that “social culture” changes have caused more widespread acceptance of what she called “transgenderism,” through support on social media, in school clubs and by celebrities who “promote and glamorize transgenderism.” Parents in her practice also “more readily embrace” trans children, as do medical professionals, she said.

“Such observation of my patients make me weary (sic) of increasing numbers of youth becoming vulnerable to adopting a movement’s ideologies, principles and behaviors merely in an effort to attain the reward of widespread affirmation and approval that the movement provides,” she said.

She said adolescence is a “critical period of identity formation and wanting to belong, and a period of vulnerability,” and she linked an increase in gender dysphoria to the rise of LGBTQ “advocacy and awareness” movements.

“To provide children with the ability to make very serious medical choices that affect their overall health and self concept for the rest of their lives, including their reproductive capability, during a season of such tremendous neurodevelopmental growth and susceptibility is risky, at best,” Nangia argued.

DeSantis and his allies have taken a number of steps to curtail gender-affirming treatment. For example, at the Department of Health’s request, state medical boards recently advanced a proposal to prohibit Florida doctors from using puberty blockers, hormone therapy or surgery to treat children diagnosed with gender dysphoria.

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