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Florida Bans Medicaid Coverage for Transgender Health Treatments

Revised rule continues efforts by Florida health authorities to discourage gender-affirming care.

By on August 12, 2022

Welcome to Florida sign – Image by Todd Franson. Original image – DonkeyHotey, via Flickr.

The Florida Agency for Health Care Administration has finalized a revised rule banning health care providers from billing Medicaid for gender-affirming medical treatments for children and adults alike.

The move comes as the state seeks to block transgender youth from accessing hormone therapy, including puberty blockers, and surgical care, based on assertions by Florida Surgeon General Joseph Ladapo, an appointee of Republican Gov. Ron DeSantis, that such treatments are “experimental and investigational,” and that there has not been sufficient research looking at the long-term effects of those treatments.

The FAHCA added new language to the rules governing Medicaid, prohibiting the government-run insurance program from covering services for treatments for gender dysphoria, or the feeling of discomfort and distress that some transgender people feel when their body doesn’t align with their gender identity. The rule also says that such treatments do not “meet the definition of medical necessity” to qualify for coverage under Medicaid.

The revised rule will take effect on Aug. 21, reports Politico.

A coalition of LGBTQ and health care rights groups, including Lambda Legal, Southern Legal Counsel, Florida Health Justice Project, and National Health Law Program, have criticized the rule banning Medicaid coverage for transgender people, noting that the ban will impact thousands of transgender Floridians, forcing them to either forego medical care or pay exorbitant out-of-pocket costs to receive treatments that their personal health care providers may deem as medically necessary.

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“Ignoring thousands of public comments and expert testimony, Florida’s AHCA has finalized a rule that will deny Medicaid coverage for all medically necessary gender-affirming care for both youth and adults,” the groups said in a joint statement. “This discriminatory and medically unsound rule will take effect on August 21, 2022, putting transgender people in jeopardy of losing access to critical gender-affirming health care services.”

The coalition also denounced what it called Florida’s “cruel effort to strip transgender Floridians on Medicaid of the ability to access essential, medically necessary, and often lifesaving medical care.”

“AHCA’s actions, at the behest of Governor DeSantis and his political appointees, are morally and legally wrong as well as medically and scientifically unsound,” the coalition said in a statement. “This rule represents a dangerous escalation in Governor DeSantis’s political zeal to persecute LGBTQ+ people in Florida, and particularly transgender youth. … We will fight this rule and defend the rights of transgender people in Florida in whatever forum necessary to protect their rights to access health care coverage that is readily available to other participants in Florida’s Medicaid program.”

The new rule is the latest step by the DeSantis administration to restrict access to gender-affirming treatments, and, for minors, to discourage them from socially transitioning, which includes using names and pronouns that do not match their assigned sex at birth, dressing in clothing not designated for their assigned sex at birth, or attempting to change the gender marker on identity documents. 

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Last Friday, the Florida Board of Medicine voted to start the rule-making process that would set standards of care for both transgender youths and trans adults, with an eye toward implementing a statewide ban preventing minors from accessing any form of gender-affirming care, according to the Miami Herald. 

Under those “standards of care,” physicians would be prohibited from providing puberty blockers, hormones, or surgical care to minors. Transgender adults seeking to transition would have to fill out “informed consent” forms that include inaccurate information about gender-affirming care and wait for 24 hours after completing the forms before receiving treatment.

In recent months, the Florida Department of Health has taken an aggressive approach, issuing a memo in April announcing its opposition to gender-affirming care for minors, on the grounds that such procedures were not fully reversible and could have long-term detrimental effects on a transgender person’s health, such as higher risk of cardiovascular disease, osteoporosis, and infertility.

That memo also discouraged social transition — which involves no medical procedures at all, based on the belief that minors are too young — and the decision-making part of their brains not sufficiently developed until age 25, well after puberty — to make life-altering decisions about how they wish to identify. The memo cited studies claiming that 80% of minors who seek out gender-affirming care will “lose their desire to identify with the non-birth sex,” which could lead to regret later in life if they pursue gender-affirming care at a young age.

The Florida Department of Health has also accused the U.S. Department of Health and Human Services and the American Academy of Pediatrics — which support allowing access to gender-affirming care when such care is deemed by a physician as “medically necessary” — of misleading the public to believe that transition-related treatments are safe and do not carry medical risks.

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Many mainstream medical and physician groups, including the American Academy of Pediatrics, the American Medical Association, and the American Academy of Child & Adolescent Psychiatry, have previously expressed support for linking people suffering from gender dysphoria to gender-affirming care, citing studies showing that transgender individuals who receive gender-affirming care experience lower rates of psychological distress, depression, anxiety, and suicidal ideation than those that do not.

Those organizations have also spoken out against ongoing efforts in many states to either ban access to gender-affirming care for minors or prohibit Medicaid dollars from being used to cover such treatments for transgender adults.

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