Florida's Medicaid Ban for Gender-Affirming Care Struck Down by Judge

A federal judge has struck down Florida’s ban on Medicaid coverage for gender-affirming care.

“The elephant in the room should be noted at the outset,” U.S. District Judge Robert Hinkle wrote in his ruling, issued Wednesday. “Gender identity is real. The record makes this clear.”

Hinkle found that the ban, in the form of a rule adopted by the Florida Agency for Health Care Administration last August, violated federal law governing Medicaid, the Affordable Care Act’s ban on sex discrimination, and the equal protection guarantee of the U.S. Constitution.

The rule denied Medicaid coverage for hormone treatment, puberty blockers, surgery, and other procedures to treat gender dysphoria, although these procedures are covered for treating other conditions. Medicaid is a joint federal-state program, administered by each state, that pays for health care for people with low incomes. The ban affected both minors and adults.

In his decision in Dekker v. Weida, a case brought by two trans adults and two trans minors in U.S. District Court for the Northern District of Florida, Hinkle had strong words for those who would deny the existence of transgender people. “There are those who believe that cisgender individuals properly adhere to their natal sex and that transgender individuals have inappropriately chosen a contrary gender identity, male or female, just as one might choose whether to read Shakespeare or Grisham,” he wrote. “Many people with this view tend to disapprove all things transgender and so oppose medical care that supports a person’s transgender existence. In this litigation, the defendants have explicitly acknowledged that this view is wrong and that pushing individuals away from their transgender identity is not a legitimate state interest.” The rule was adopted “for political reasons,” Hinkle said.

“Still, an unspoken suggestion running just below the surface in some of the proceedings that led to adoption of the rule and statute at issue — and just below the surface in the testimony of some of the defense experts and AHCA consultants — is that transgender identity is not real, that it is made up,” the judge continued. “And so, for example, one of the defendants’ experts, Dr. Paul Hruz, joined an amicus brief in another proceeding asserting transgender individuals have only a ‘false belief’ in their gender identity — that they are maintaining a ‘charade’ or “delusion.” An AHCA consultant, Dr. Patrick Lappert — a surgeon who has never performed gender-affirming surgery — said in a radio interview that gender-affirming care is a ‘lie,’ a ‘moral violation,’ a ‘huge evil,’ and ‘diabolical.’ State employees or consultants suggested treatment of transgender individuals is either a ‘woke idea’ or profiteering by the pharmaceutical industry or doctors.”

Hinkle not only invalidated the rule but ordered Medicaid payment for all the care the plaintiffs receive going forward and prevented the AHCA and its head, Jason Weida, from standing in the way of their receiving the care.

Weida and the AHCA were the defendants in the suit. The plaintiffs were trans adults August Dekker and Brit Rothstein, and two minors identified under pseudonyms, Susan (represented by her parents, Jane and John Doe) and K.F. (represented by his mother, Jade Ladue). The plaintiffs were represented by Lambda Legal, Southern Legal Counsel, Florida Health Justice Project, and National Health Law Program, together with international law firm Pillsbury Winthrop Shaw Pittman LLP.

Hinkle’s ruling is the second pro-trans decision to come from a federal court in two days. U.S. District Judge James M. Moody Jr. Tuesday struck down the Arkansas ban on gender-affirming care for trans minors. Arkansas plans to appeal, and Florida likely will as well.

But meanwhile, the plaintiffs, their lawyers, and their allies are celebrating.

“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. 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,” plaintiff August Dekker, a 29-year-old transgender man from Hernando County, Fla., said in a Lambda Legal press release.

“Gender-affirming medical care is evidence-based care. In court what matters are the facts and the law, not fearmongering and heated rhetoric. 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,” added Omar Gonzalez-Pagan, counsel and health care strategist at Lambda Legal. “We are gratified by today’s result which protects access to care for some of the most vulnerable Floridians, transgender Medicaid beneficiaries. It is unfortunate that Florida politicians like [Gov.] Ron DeSantis have sought to attack the most vulnerable to score political points. However, today’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.”

Trans advocate and academic Alejandra Caballo tweeted, "Florida has lost their case denying trans people medicaid coverage for gender affirming care. This is another final judgment. The precedent could be used to challenge restrictions on adult care in Florida. The wins keep coming!"