Respect Equality

Florida publishes rule barring Medicaid coverage for gender-affirming health care

The rule is set to take effect Aug. 21.
(Nicky Ebbage/iStock / Getty Images Plus)

Story at a glance

  • Florida’s Medicaid program will no longer cover gender-affirming medical care including puberty blockers, hormones or surgeries for transgender recipients under a new state rule.

  • Florida’s Agency for Health Care Administration (AHCA), which controls most of the state’s Medicaid program, in June published a report claiming gender-affirming treatments were “experimental” and “investigational.”

  • In eight other states, transgender Americans may not use Medicaid to help pay for gender-affirming health care.

Transgender Medicaid recipients in Florida will no longer be able to use Medicaid to cover gender-affirming health care under a new state rule that will take effect later this month.

The rule published Wednesday by Florida’s Agency for Health Care Administration (AHCA), which controls most of the state’s Medicaid program, eliminates coverage for gender-affirming health care for transgender Floridians of all ages. It will go into effect Aug. 21.

Under the rule, Florida residents will no longer be allowed to use Medicaid to help pay for puberty blockers, hormones, gender-affirming surgeries or “any other procedures that alter primary or secondary sexual characteristics” when those procedures are used to treat gender dysphoria.

In a joint statement on Thursday, Lambda Legal, the Southern Legal Counsel, the Florida Health Justice Project and the National Health Law Program called the move “medically and scientifically unsound” and said it was politically motivated.

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“This rule represents a dangerous escalation in Governor DeSantis’s political zeal to persecute LGBTQ+ people in Florida, and particularly transgender youth,” the groups wrote. In March, Florida Gov. Ron DeSantis (R) signed into law a measure that heavily restricts how public school teachers may speak to their students about gender identity and sexual orientation, accusing educators of trying to “sow doubt” in children about their gender.

DeSantis earlier this month suspended Andrew Warren, an elected state attorney in Tampa, after Warren said he would not prosecute people who receive abortions or gender-affirming medical care in Florida. The governor said Warren was a supporter of “disfiguring young kids.”

In June, the AHCA in a report said several treatments for gender dysphoria, including puberty blockers and hormones, are inconsistent with “generally accepted professional medical standards,” calling them “experimental” and “investigational.”

Most major medical associations, including the American Medical Association and the American Academy of Pediatrics, reject insurance exclusions for gender-affirming health care, which they say is medically necessary and often life-saving.

The AHCA report has been criticized by clinicians who treat transgender patients as being “unscientific,” and has been accused of relying on research from doctors with anti-transgender biases, including experts from the American College of Pediatricians – an organization designated as a hate group by the Southern Poverty Law Center. The group has contested this designation.

Florida now joins eight other states with Medicaid programs that explicitly exclude coverage for gender-affirming health care, according to the Movement Advancement Project, which tracks such measures. Exceptions include Ohio, where officials have said the ban is not being enforced, and Arkansas, whose 2021 Medicaid ban only applies to minors.

Judges in Georgia and West Virginia recently ruled that the states’ Medicaid programs could not exclude coverage for gender-affirming surgical care.

The Florida Board of Medicine last week voted to initiate the rule-making process to establish a new standard of care for transgender youth based on recommendations from the state Health Department.

“Given the lack of quality evidence in support of gender transition treatments, the use of such treatments for gender dysphoria should be considered experimental and should require fully informed consent of the risks and limitations,” a petition filed earlier this month by the department states.

It adds that youth younger than 18 do not possess the “cognitive or emotional maturity” to comprehend the consequences of receiving gender-affirming medical care.

Guidance issued by Florida’s Health Department in April drew sharp criticism over a suggestion that gender-affirming health care – including social transition – should not be accessible to minors at all.

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