Florida’s Medicaid Pay Ban for Transgender Care Tossed by Judge

Florida’s Medicaid agency can’t lawfully refuse to pay for gender-affirming care, a federal judge in Florida held Wednesday following a nonjury trial.

A blanket exclusion on payments for certain gender dysphoria treatments, including puberty blockers and cross-sex hormones for both adults and minors, violates the Medicaid Act, Section 1557 of the Affordable Care Act, and the 14th Amendment’s equal protection clause, according to Judge Robert L. Hinkle of the US District Court for the Northern District of Florida.

West Virginia and Idaho also are defending suits over Medicaid exclusions for transgender care, and more lawsuits may be coming. At least seven other states expressly ban coverage for transgender-related health care, according to the Movement Advancement Project, a think tank that researches LGBTQ+ issues.

Hinkle rejected arguments by the Florida Agency for Health Care Administration and Secretary Jason Weida that the treatments are experimental and that the Medicaid Act allows Florida to deny coverage for them.

“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,” Hinkle said.

The case is similar to one involving West Virginia’s restriction on Medicaid pay for certain transgender care. The US Court of Appeals for the Fourth Circuit has tentatively scheduled en banc oral arguments in that case for mid-September.

Hinkle recently blocked Florida from enforcing a ban on gender-affirming care for minors in an opinion that declared that gender dysphoria is “real,” and that lawmakers were motivated by bigotry.

The trial in the Medicaid case began May 9 and concluded May 22.

Lambda Legal, Southern Legal Counsel Inc., Florida Health Justice Project, Pillsbury Winthrop Shaw Pittman LLP, and the National Health Law Program represent the plaintiffs, a group of trans minors and their parents. Holtzman Vogel Baran Torchinsky & Josefiak PLLC represents the state defendants.

The case is Dekker v. Weida, N.D. Fla., No. 22-cv-325, 6/21/23.