A legislative committee on Friday released a report about an LGBTQ+ clinic at the University of Mississippi Medical Center that came under fire last year after lawmakers were angered to learn it had provided gender-affirming care to trans youth.

UMMC leadership ultimately decided the “Trustworthy, Evidence-based, Affirming, Multidisciplinary,” or TEAM, clinic should stop seeing trans kids last fall even though gender-affirming care for minors was legal at the time, according to emails obtained by Mississippi Today.

It wasn't until earlier this year that lawmakers passed House Bill 1125, which banned the provision of gender-affirming care to trans minors in Mississippi. 

READ MORE: ‘Facing political pressure, UMMC cut care to trans kids before the Legislature banned doing so, emails show'

The purpose of Friday's brief published by the Joint Committee on Performance Evaluation and Expenditure Review, or PEER, was to provide lawmakers with an overview of — and the sources of funding for — gender-affirming care at the TEAM clinic. The report also provides a summary of HB 1125.

It asks basic questions like “why did UMMC open the TEAM clinic,” “how does the TEAM clinic operate” and “what services are provided by the TEAM clinic?”

The answers paint a picture of a shoestring clinic without its own dedicated physical space that operated on private funds and was staffed by the goodwill of 18 employees who had other primary responsibilities at UMMC. The TEAM clinic, founded in 2015, sought to provide a slate of health services in an inclusive environment for LGBTQ+ Mississippians. That included primary care and more specialized services like mental health and gender-affirming care. 

Despite conservative lawmakers and blogs claiming that state funding was paying “for mutilation of children,” the TEAM Clinic mainly ran on patient revenue and grant funding from three sources: The Women's Foundation of Mississippi, the LGBTQ Fund of Mississippi and the Manning Family Fund. 

The TEAM clinic did not provide surgery to patients under the age of 18. For adults, surgical referrals to UMMC's Plastic Surgery Department were provided.

Most of the patient revenue that supported the clinic over a roughly three-year period beginning in fiscal year 2020 came from Blue Cross Blue Shield of Mississippi ($55,051) and other commercial insurances. The Mississippi Division of Medicaid paid out $24,122 in claims, according to the report, about 17% of the amount billed by UMMC for services at the TEAM clinic.

A very small portion of state funding — an estimated $1,215 in fiscal year 2022 — paid for the few hours that providers spent at the TEAM clinic on the first Friday of every month.

The miniscule amount of state funding is similar to what PEER discovered when it also sent inquiries to Mississippi Medicaid to determine how much the agency paid out in claims associated with gender identity disorder or gender dysphoria.

All told, it took approximately $25,000 a year to support the clinic's operations, the PEER found.

The clinic saw less than 300 patients in the same three-year period, an estimate that might be “overinflated” due to the way UMMC maintained confidentiality in its patient count, the report found.

Just 221 people in that same period sought “gender transition services” at the TEAM Clinic, which the report appears to have counted as services ranging from “behavioral health” to prescriptions like puberty blockers and hormone therapy.

Over the three-year period, PEER estimated that just 53 patients under the age of 18 received gender transition services.

But the report says that “in FY 2024, the number of minors served in the Clinic should be zero.”

That number is due to HB 1125 but also to UMMC's decision, made many months before the bill passed, to stop providing gender-affirming care like hormone therapy and puberty blockers to trans youth at the TEAM clinic. The PEER committee's report may have been a factor in that decision.

The first inkling UMMC received of lawmakers' interest in the clinic came on Aug. 31 when UMMC Vice Chancellor and Dean of the School of Medicine Dr. LouAnn Woodward was sent via hand mail a letter from the committee that was then forwarded to the TEAM clinic.

PEER's letter requested “certain information regarding services provided by and payments provided to UMMC regarding gender transition services,” including how many services were provided to youth and adults and what amount had been subsidized by taxpayers or billed to Mississippi Medicaid.

Lawmakers had asked about the clinic in the past, but this time, PEER's letter was followed by what Kristy Simms, UMMC's point person with elected officials at the state and federal level, described as “dozens of inquiries,” according to emails obtained by Mississippi Today.

After Simms talked with lawmakers, emails show she proposed UMMC consider shutting down the clinic. She characterized her conversations with lawmakers, including Sam Mims, the chair of the House Public Health and Human Services Committee, as “hostile and slightly threatening.”

“It's looking more and more like we have two options,” she wrote on Sept. 12. “Pause or shutter some/all of the work of the Center or be told to do so by the legislature in January.”

Staring in early October, the TEAM clinic began implementing leadership's decision to stop providing gender-affirming care to trans kids, a move that impacted services across the hospital — and left parents and patients scrambling.

“Because it was such a welcoming environment, I couldn't believe that they had just dropped patients like that,” Raymond Walker, a trans teenager who had sought care at the clinic, told Mississippi Today in April. “I was just completely blindsided.”

The emails also show UMMC leadership pondering if they should begin “dismantling” the TEAM in response to lawmakers' inquiries. 

The PEER report ends with a recommendation for a way UMMC could do that.

“UMMC could consider integrating services provided by the TEAM Clinic back into UMMC's regular care setting, similar to the way it did with services provided to minors, and offer optional LGBTQ training courses to all staff and students,” the report says.

Now law, HB 1125 provides that any Mississippian, including doctors, can be held civilly liable for “conduct” that aids and abets the provision of gender-affirming care for trans youth, but advocates and attorneys have noted it's unclear what that looks like.

UMMC has yet to answer that, but PEER notes the hospital's attorneys are working to understand if its providers “will be allowed to refer patients to providers outside of the state, or if that would be considered aiding or abetting as provided in the law.”

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.