Judge strikes down Florida Medicaid policy excluding gender-affirming care

A Florida rule excluding gender-affirming health care from Medicaid coverage is unlawful and unconstitutional, a federal judge ruled Wednesday, adding that the policy, enacted last year under the administration of Republican Gov. and presidential candidate Ron DeSantis, is based on politics rather than medicine.

Florida’s Agency for Health Care Administration (AHCA), which controls most of the state’s Medicaid program, in August adopted a rule barring transgender residents from using Medicaid to help cover the cost of puberty blockers, hormone replacement therapy, surgeries or “any other procedures that alter primary or secondary sexual characteristics” when those procedures are used to treat gender dysphoria.

The rule was immediately criticized by LGBTQ civil rights groups and health care professionals, who characterized it as “medically and scientifically unsound” and politically motivated. Two transgender adults and a minor then sued AHCA officials in federal court, claiming in a September lawsuit filed in the Northern District of Florida that the rule discriminates based on sex and transgender status.

In a 54-page decision Wednesday, U.S. District Judge Robert Hinkle, who partially blocked the enforcement of another Florida law restricting access to gender-affirming health care earlier this month, sided with the plaintiffs, finding the AHCA rule and a separate statute prohibiting the use of state funds for “sex reassignment prescriptions or procedures” violate federal law and the U.S. Constitution.

“Florida has adopted a rule and statute that prohibit Medicaid payment for these treatments even when medically appropriate,” Hinkle wrote Wednesday. “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,” Hinkle added.

In Wednesday’s ruling, Hinkle also suggested Florida’s Medicaid rule was adopted in pursuit of a political goal.

“For many years, Florida’s Medicaid system paid for medically necessary treatments for gender dysphoria. Recently, for political reasons, Florida adopted a rule and then a statute prohibiting payment for some of the treatments,” Hinkle wrote Wednesday.

Hinkle’s ruling also characterizes a June AHCA report asserting gender-affirming medical care does not meet the requirements for Medicaid because it is experimental as “flawed” and “from the outset, a biased effort to justify a predetermined outcome, not a fair analysis of the evidence.”

An AHCA employee in a June email to Christopher Cogle, the chief medical officer of Florida Medicaid, suggested state health officials did not follow customary procedures for developing generally accepted professional medical standards (GAPMS) in creating the report.

Every major medical organization supports the administration of gender-affirming health care for transgender youths and adults as medically necessary and often life-saving by every major medical organization. Most have also explicitly rejected insurance exclusions for transition-related care.

In a statement Wednesday, August Dekker, a 29-year-old transgender man and one of the plaintiffs in the case challenging Florida’s Medicaid exclusion, said he is “extremely relieved and pleased” with Hinkle’s decision.

“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,” Dekker said. “I am also happy for other transgender Floridians that get care through Medicaid, as now access to that lifesaving, critical care can continue.”

Wednesday’s ruling is the second legal victory for transgender rights in the South in as many days. On Tuesday, a federal judge struck down an Arkansas law banning youth access to gender-affirming health care, which was the first such law in the the nation.