Judge strikes down Florida's ban on Medicaid coverage for gender-affirming care

A federal judge has struck down a controversial Florida rule and statute that prohibited Medicaid coverage for gender-dysphoria treatment, siding with LGBTQ advocates and doctors who argued the ban was unconstitutional and unlawful.

"Gender identity is real. The record makes this clear," U.S. District Judge Robert Hinkle wrote in his ruling Wednesday.

In August, Florida's Agency for Health Care Administration enacted a rule that said Florida Medicare does not cover puberty blockers, hormones, sex reassignment surgeries and any other procedures that alter one's sexual characteristics as part of treatment for gender dysphoria.

The rule was swiftly rebuked by LGBTQ advocates and doctors, as it goes against every credible medical association, which supports the administration of gender-affirming care, including for minors.

The rule and a statute that followed, which prohibited state funds from going to "sex reassignment prescriptions or procedures," were then met by a lawsuit filed by August Dekker and Brit Rothstein, two transgender adults, and two transgender minors identified in court documents as Susan Doe and K. F.

In his ruling Wednesday, Hinkle, who was first appointed by former President Bill Clinton, ruled that both the rule and statute violate the federal Medicaid statute of the Equal Production Clause and the Affordable Care Act's prohibition on sex discrimination as the Florida moves prohibited coverage for medically appropriate treatment.

Among his reasonings, Hinkle said that to deny Medicaid coverage for transgender patients for drugs covered for cisgendered patients "survives neither intermediate nor rational-basis scrutiny."

He said the process that resulted in the rule was political and its conclusion that gender-affirming medical care was considered experimental "was contrary to generally accepted medical standards."

He said the process was, from the start, "a biased effort to justify a predetermined outcome" and was "not a fair analysis of the evidence."

Hinkle continued that while defendants in the case have said that pushing individuals away from their transgender identity is not a legitimate state interest, an "unspoken suggestion running just below the surface" in some of the proceedings that led to the rule's adoption is that transgender identify it not real.

"Any proponent of the challenged rule and statute should put up or shut up: do you acknowledge that there are individuals with actual gender identities opposite their natal sex, or do you not? Dog whistles ought not be tolerated," he said.

Dekker, 29, said he is "extremely relieved and pleased" by the decision as he will no longer need to worry about his ability to receive medical care.

"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 healthcare," he said in a statement. "I am also happy for other transgender Floridians that get care through Medicaid as now access to that lifesaving, critical care can continue."

The ruling comes amid a state-level Republican effort to restrict access to gender-affirming care, especially for minors.

According to Movement Advancement Project, a nonprofit think tank, at least 19 states have bans on both medicinal and surgical forms of gender-affirming medical care for minors

On Tuesday, a federal judge struck down Arkansas' ban on gender-affirming care for youth on the grounds the law was unconstitutional.

A little more than a month ago, Florida's Republican governor, Ron DeSantis, who is also a presidential hopeful, signed into law a package of bills that banned minors from receiving gender-affirming care.

Earlier this month, Hinkle halted the ban on the grounds that the state was prohibiting medically appropriate treatment.

According to the UCLA's Williams Institute, there are an estimated 94,900 transgender Floridian adults, representing a little more than half a percent of the state's population.

"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, director of the Transgender Rights Initiative at Southern Legal Counsel, said in a statement.

"Today's ruling sends a strong message that the state of Florida cannot continue to play politics with people's lives."