Judge Blocks FL Ban on Medicaid Coverage for Gender-Affirming Care

A federal judge has blocked Florida’s ban on Medicaid coverage for gender-affirming care, stating that the rule violated federal law and was politically motivated.

The ban’s inception dates back to August 2022, when the Florida Agency for Health Care Administration (AHCA) finalized rules banning healthcare providers from billing Medicaid for gender-affirming medical treatments.

Specifically, the rules said that Medicaid would not cover puberty blockers, hormone therapies, or surgical procedures to treat gender dysphoria—a common diagnosis for transgender individuals.

In September 2022, LGBTQ+ advocacy groups filed a federal lawsuit challenging the ban on behalf of four Florida Medicaid beneficiaries who were either transgender or parents of transgender youth. The advocacy groups estimated that 9,000 transgender people in Florida rely on Medicaid coverage for gender-affirming care.

In the most recent ruling, US District Judge Robert Hinkle sided with the plaintiffs and declared that Florida’s prohibition is unconstitutional and politically motivated. Hinkle stated that the law violated the federal Medicaid statute, the Equal Protection Clause, and the Affordable Care Act’s prohibition of sex discrimination.

“The loss of Medicaid payment for the needed treatments is an injury in fact; it is concrete and particularized; and it is actual or imminent, not conjectural or hypothetical,” the ruling stated. “The injury is traceable to the challenged rule and statute, either of which, standing alone, would require the plaintiffs to forgo or pay out-of-pocket for the needed treatment, or move out of Florida. The injury will be redressed by a favorable decision.”

Part of the state’s decision to ban Medicaid coverage of gender-affirming care was based on a 2022 analysis the Executive Office of the Governor directed AHCA to conduct. The report determined that gender-affirming care was not supported by generally accepted medical standards and was experimental. However, this conclusion did not have supporting evidence and went against generally accepted medical standards.

The state’s prohibition also reflected targeted discrimination against transgender individuals, Hinkle said.

“There has long been, and still is, substantial bigotry directed at transgender individuals. And even when not based on bigotry, there are those who incorrectly but sincerely believe that gender identity is not real but instead just a choice,” the lawsuit read.

The ruling declared that gender identity is real and Medicaid beneficiaries are entitled to payment for their medically necessary gender-affirming care. The Florida laws are “invalid to the extent they categorically ban Medicaid payment for puberty blockers and cross-sex hormones for the treatment of gender dysphoria,” Hinkle wrote.

The decision restores Medicaid coverage of hormone therapy and puberty blockers for the plaintiffs and allows all Medicaid beneficiaries in the state to seek coverage for gender-affirming care. Like all healthcare services, coverage decisions will be made case-by-case.

Securing coverage of gender-affirming care can help mitigate the barriers transgender people already face when accessing healthcare.

A KFF report highlighted how transgender individuals often experience discrimination from healthcare providers and are more likely to face mental health challenges than cisgender people. However, mental healthcare access for transgender people is lacking. Over half of transgender adults under age 35 said they had unmet mental healthcare needs in the past year, primarily due to costs.