Lawyers representing the plaintiff in the case challenging Florida’s Medicaid ban on gender-affirming care. – Photo: Lambda Legal.
A federal judge has struck down a Florida administrative rule prohibiting Medicaid from covering the cost of gender-affirming medical treatments that assist a transgender-identifying person in transitioning.
The rule, approved last August by the Florida Agency for Health Care Administration, applies to treatments sought out by both minors and adults, declaring that transition-related treatments do not “meet the definition of medical necessity” to qualify for coverage under Medicaid.
The rule was passed as Florida officials have sought to crack down on all forms of LGBTQ visibility, including passing a law blocking transgender youth from accessing gender-affirming treatments.
Under the administration of Republican Gov. Ron DeSantis, the Florida Board of Medicine and Florida Surgeon General Joseph Ladapo have deemed all gender-affirming treatments “experimental and investigational.” The board has since crafted additional rules throwing up additional obstacles for adults to access transition-related care, such as requiring patients to see only a doctor, in person, before every course of treatment, and to sign “informed consent” forms portraying gender-affirming treatments as dangerous to their health.
Two transgender adults and two minors, represented by their parents for legal purposes, subsequently sued the Florida Agency for Health Care Administration and its head, Secretary Jason Weida, in federal court.
The plaintiffs claimed the rule prohibiting Medicaid from covering gender-affirming care, and a section of the law banning access to transition-related health care imposing identical prohibitions on coverage, are discriminatory on the basis of gender identity and sex, and violate provisions requiring Medicaid to include all necessary services needed to treat a physical or mental health condition, and to cover the same kinds of treatments for transgender patients that would covered for non-transgender patients.
Following a recent two-week trial, U.S. District Judge Robert Hinkle, of the Northern District of Florida, issued a decision on Wednesday finding the ban on Medicaid coverage to be unlawful and unconstitutional. Hinkle ordered FAHCA to stop attempting to enforce the ban on coverage.
Hinkle’s ruling also nullified the Medicaid ban contained in the state’s law banning gender-affirming care for minors — which Hinkle had previously blocked from taking effect, in a separate ruling.
“Gender identity is real. Those whose gender identity does not match their natal sex often suffer gender dysphoria. The widely accepted standard of care calls for evaluation and treatment by a multidisciplinary team. Proper treatment begins with mental-health therapy and is followed in appropriate cases by GnRH agonists and cross-sex hormones,” Hinkle wrote in his findings of fact.
“Florida has adopted a rule and statute that prohibit Medicaid payment for these treatments even when medically appropriate,” Hinkle continued. “The rule and statute violate the federal Medicaid statute, the Equal Protection Clause, and the Affordable Care Act’s prohibition of sex discrimination. These plaintiffs are Medicaid beneficiaries who are entitled to payment, as a matter of medical necessity, for puberty blockers or cross-sex hormones as appropriately determined by their multidisciplinary teams of providers.”
The plaintiffs in the case, and their legal teams, including representatives from LGBTQ legal and health advocacy groups such as Lambda Legal, Southern Legal Counsel, Florida Health Justice Project, and National Health Law Program, celebrated Hinkle’s ruling, which has delivered a second defeat to the DeSantis administration when it comes to restricting forms of transgender health care.
“I am extremely relieved and pleased with this decision so I don’t have to worry about whether I will be able to get the medical care I need,” lead plaintiff August Dekker, a 29-year-old transgender man from Hernando County, Florida, said in a statement. “Florida’s policy effectively denied me the treatment my doctors recommended, because as a low-income Floridian with disabilities, I rely on Medicaid to afford my health care. I am also happy for other transgender Floridians that get care through Medicaid, as now access to that lifesaving, critical care can continue.”
“Gender-affirming medical care is evidence-based care. In court what matters are the facts and the law, not fear-mongering and heated rhetoric,” Omar Gonzalez-Pagan, counsel and health care strategist for Lambda Legal, said in a statement.
“Over a two-week trial, the court heard from our clients, who have benefited from gender-affirming medical care, and from a contingent of medical and scientific experts from various disciplines. Through overwhelming evidence, we demonstrated that gender-affirming care is not experimental but rather essential, safe, and effective medical care,” Gonzalez-Pagan continued. “[T]oday’s ruling makes clear that discrimination is wrong and recognizes that every person in Florida, including transgender people, deserves equal access to evidence-based and lifesaving medical care.”
“The Court’s order is a much-needed win for Floridians, amidst a climate where the rights of transgender individuals are being relentlessly attacked by the state,” Simone Chriss, the director of the Transgender Rights Initiative at Southern Legal Counsel, said in a statement. “Judge Hinkle said it best — ‘the statute and the rule were an exercise in politics, not good medicine’ – and [the] ruling sends a strong message that the state of Florida cannot continue to play politics with people’s lives. We are so grateful to the courageous plaintiffs who made this case possible, and so grateful to the Court for holding the state accountable for its unapologetic bigotry.”
Federal Judge Victoria Calvert has permanently blocked a portion of Georgia’s law banning prisoners from receiving gender-affirming care, ruling on Dec. 3 that the state’s blanket ban on hormone therapy violates the Eighth Amendment’s prohibition on cruel and unusual punishment.
Signed by Gov. Brian Kemp in May and implemented in July, the law bars prisoners from receiving hormone therapy or other treatment for gender dysphoria -- even when a doctor deems it medically necessary. It prohibits the state from funding such care and blocks transgender inmates from paying for it themselves. Non-transgender prisoners, however, may still receive hormone therapy and other gender-affirming treatments so long as the care is not related to gender transition.
On Monday, November 10, the U.S. Supreme Court rejected former Kentucky county clerk and same-sex marriage opponent Kim Davis' appeal of a lower court's decision against her -- including a petition demanding that the court revisit and overturn its landmark ruling legalizing same-sex marriage.
The nation's highest court denied a writ of certiorari, which would have signaled its intention to review Davis' case -- and the 2015 Obergefell v. Hodgesdecision, which struck down state-level bans on same-sex marriage. It would have taken four justices to agree to hear Davis' challenge.
U.S. Catholic bishops have voted to bar Catholic hospitals from providing transgender patients with gender-affirming care, including hormones and surgical procedures.
The vote, taken last week during the U.S. Conference of Catholic Bishops' plenary assembly in Baltimore, updates the "Ethical and Religious Directives for Catholic Health Care Services," the Church's rulebook governing medical procedures it deems immoral.
The directives spell out how Catholic-affiliated hospitals and staff should respond to medical situations that may clash with personal religious beliefs or Church teaching on issues like end-of-life care, contraception, abortion, or gender identity.
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