A federal judge has ruled that a Florida rule excluding gender-affirming health care from Medicaid coverage is illegal and unconstitutional. The judge stated that the policy, which was implemented last year under the administration of Republican Governor Ron DeSantis, is driven by politics rather than medical considerations. The Florida Agency for Health Care Administration (AHCA), which oversees the state’s Medicaid program, enacted a rule in August that prevents transgender residents from using Medicaid to cover the cost of treatments such as puberty blockers, hormone replacement therapy, and surgical procedures used to treat gender dysphoria. LGBTQ civil rights groups and healthcare professionals immediately criticized the rule as medically unsound and politically motivated. In response, two transgender adults and a minor filed a lawsuit against AHCA officials, alleging discrimination based on sex and transgender status. In his 54-page decision, U.S. District Judge Robert Hinkle, who previously blocked the enforcement of another Florida law restricting access to gender-affirming health care, ruled in favor of the plaintiffs, finding that the AHCA rule and a separate statute prohibiting state funds from being used for “sex reassignment prescriptions or procedures” violate federal law and the U.S. Constitution. Judge Hinkle emphasized that Medicaid beneficiaries should be entitled to receive payment for puberty blockers and cross-sex hormones when deemed medically necessary by their multidisciplinary care teams. He also suggested that Florida’s Medicaid rule was politically motivated, noting that the state’s Medicaid system previously covered medically necessary treatments for gender dysphoria. Furthermore, the judge criticized an AHCA report claiming that gender-affirming medical care does not meet Medicaid requirements as biased and flawed. The report apparently did not follow customary procedures for developing generally accepted professional medical standards. The administration of gender-affirming health care is supported by every major medical organization as medically necessary and often life-saving. In response to the ruling, one of the plaintiffs expressed relief and satisfaction, stating that Florida’s policy had denied him recommended treatment due to his reliance on Medicaid as a low-income individual with disabilities. This ruling follows a recent legal victory for transgender rights in Arkansas, where a federal judge struck down the nation’s first law banning youth access to gender-affirming health care.
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