April 16,2024

State Attorneys General Misused Medicaid Authority to Persecute Teens Seeking Gender Affirming Care, Finance Inquiry Finds; Politicized Requests for Patient Information Caused Spike in Teen Crisis Mental Health Calls

Tennessee Hospital Betrayed its Responsibility to Patients by Complying with Questionable Requests from State Investigators for Sensitive Patient Medical Records; Other Providers Challenged Unjustified Records Requests

Washington, D.C. – Senate Finance Committee Chair Ron Wyden, D-Ore., released a staff report today finding that state attorneys general misused their Medicaid investigative and consumer protection authorities to persecute teens and adults seeking transgender health care, harming patients and causing a spike in LGBTQIA+ teens and adults seeking crisis mental health services. 

The report by the committee’s majority staff reviewed publicly available information about trans health care record demands by attorneys general in Tennessee, Indiana, Missouri and Texas, and how medical providers responded to those requests. Committee staff also obtained correspondence between a major provider in Tennessee and the state attorney general. While some providers fought against overbroad requests for detailed medical records, the Vanderbilt University Medical Center (VUMC) handed over large amounts of lightly-redacted patient information, to the Tennessee attorney general. In contrast to the response by VUMC, Washington University in St. Louis (WashU) refused to share patient records with the Missouri Attorney General, citing patient privacy concerns and questioning whether the Missouri Attorney General had the authority to investigate. Seattle Children’s Hospital sued to block the release of medical records to the Texas Attorney General, citing a range of jurisdictional arguments.

“A handful of red-state attorneys general are misusing their authority to terrorize transgender teens in their states, violating patients’ privacy, and causing real harm to vulnerable kids and adults in the process. It’s shameful that law-enforcement officials are choosing to persecute teens trying to live their lives, just to score points with far-right activists ” Wyden said. “At the same time, while some hospitals have admirably resisted these overbroad fishing expeditions, Vanderbilt University Medical Center failed its responsibility to protect their patients’ privacy. Giving up on patient privacy, particularly after the repeal of Roe v. Wade, opened the door to criminalizing women’s private reproductive health choices and is an utter betrayal of a medical provider’s responsibility. ”

As a result of a well-publicized investigation by the Tennessee attorney general into young adults seeking transgender health care, Rainbow Youth Project (RYP), an organization that provides emergency behavioral health care, responded to 376 acute mental health crises from LGBTQ+ youth in the area in a single day, more than 100 times the project’s average call volume. 

As part of that investigation, the Vanderbilt University Medical Center turned over 65,000 pages of documents, including the medical records of at least 82 transgender patients, to the Tennessee Attorney General. 

States typically house Medicaid Fraud Control Units (MFCUs) within Attorneys General offices, which are authorized to investigate and prosecute Medicaid provider fraud. The fundamental purpose of the investigations at-issue here, however, is to target transgender individuals by accessing extensive personally-identifiable information and documents, including medical records. This is a misuse of this health oversight authority with catastrophic implications for transgender Americans.

Read the full Finance Committee majority staff report here