Federal judge knocks down Florida’s Medicaid ban on gender-affirming treatment
“Gender identity is real. The record makes this clear,” U.S. District Judge Robert Hinkle said.
TALLAHASSEE, Fla. — A federal judge struck down Florida’s prohibition on Medicaid coverage for gender-affirming care, the second decision to upend restrictions put into place at the urging of Gov. Ron DeSantis.
U.S. District Judge Robert Hinkle on Wednesday ruled against the ban by using some of the same conclusions and language that he used in another recent decision where he determined three Florida transgender minors could receive “puberty blockers” and other types of gender-affirming care despite a state-enacted prohibition on such treatment for those under the age of 18. In both rulings, Hinkle has stated that “gender identity is real. The record makes this clear.”
This latest decision, however, is not just limited to those who brought a lawsuit against the state. It applies to the mammoth, multibillion-dollar safety net health care program that is paid for by a mix of state and federal tax dollars. Those who filed the initial legal challenge estimated that up to 9,000 Medicaid enrollees in Florida are transgender.
“There is no rational basis for a state to categorically ban these treatments or exclude them from the state’s Medicaid coverage,” stated Hinkle, who was first appointed to the court by former President Bill Clinton.
Hinkle ruled that the ban on Medicaid paying for hormone therapy or “puberty blockers” was an equal protection violation and went against federal Medicaid law as well as the Affordable Care Act. He called the restrictions “purposeful” discrimination against transgender individuals and not a “legitimate state interest.” The lawsuit was brought against the state on behalf of two transgender adult men and the families of two transgender minors.
Hinkle, in his ruling, pointed out that Florida’s main health care agency had previously signed off on having Medicaid cover certain gender-affirming care treatments several years ago. But then the state conducted a new analysis that he called “a biased effort to justify a predetermined outcome, not a fair analysis of the evidence.” He also said that the Agency for Health Care Administration “conducted a well-choreographed public hearing that was an effort not to gather facts but to support the predetermined outcome.”
The governor’s office did not immediately respond to a request for comment about the ruling, which comes a month after the trial in federal court wrapped up.
The DeSantis administration last year began pushing for limits on gender-affirming care, which included both the prohibition on Medicaid spending as well as a ban on treatments for minors. The Florida Legislature this past spring codified both into state law with some legislators calling the treatments for minors “evil” and “child abuse.”
During a bill signing ceremony, DeSantis said the new law would “permanently outlaw the mutilation of minors,” adding that puberty blockers would bring on “irreversible changes.”
The American Academy of Pediatrics and the American Medical Association support gender-affirming care for adults and adolescents. But medical experts said gender-affirming care for children rarely, if ever, includes surgery. Instead, doctors are more likely to recommend counseling, social transitioning and hormone replacement therapy.
Hinkle earlier this month blocked the ban on treatment for minors, but only for three transgender youths whose parents had sued the state on their behalf. The preliminary injunction in that separate case does not apply to other minors who may wish to obtain treatment, but the ruling suggests that a key part of the law itself could get knocked down as the legal challenge proceeds.
Several states have recently enacted laws aimed at treatments provided to those with gender dysphoria, which refers to the feelings of discomfort or distress some transgender people experience when their bodies don’t align with their gender. A federal judge on Wednesday issued a permanent injunction against an Arkansas ban on gender affirming care for minors.