Federal judge upholds Florida Medicaid ban on covering gender-affirming care

TALLAHASSEE, Fla. — A federal court judge on Wednesday allowed a Florida rule to continue that bars the state Medicaid program from reimbursing patients for most forms of gender-affirming care.

Judge Robert Hinkle denied a preliminary injunction request from a coalition of transgender rights groups seeking to stop the rule. The groups previously filed a lawsuit against Florida over its ban on Medicaid covering the cost of gender affirming care.

Hinkle said the lawsuit addressed a potential violation of Medicaid law rather than a broader constitutional issue. The lawsuit alleged the state violated parts of the equal protections clause of the Constitution and anti-discriminatory language in the Affordable Care Act and the Medicaid Act.

“There’s nothing wrong with the state saying they will approve treatment for this and not that,” Hinkle said shortly before he ruled against the preliminary injunction from the bench. “The question here is about the Medicaid statute.”

The Florida Agency for Health Care Administration created the rule that banned covering gender-affirming treatments such as hormone therapy and surgery in August.

The groups filed the lawsuit on behalf of four people — August Dekker, Brit Rothstein, and two 12-year-old children identified in the lawsuit as “Susan,” who is a transgender girl, and “K.F.,” who is a transgender boy. Rothstein was already pre-approved by AHCA, which regulates the state Medicaid program, to have gender-affirming surgery in December.

Florida is one of at least 10 states in the country that blocks Medicaid coverage for gender-affirming care, which can include behavioral therapy, hormone-blocking medications and, in rare instances, surgery.

Lambda Legal Counsel Omar Gonzalez-Pagan told Hinkle that Rothstein’s surgery was cancelled after AHCA finalized the new rule.

“It was scheduled and then this rule came, and now it’s not happening anymore,” Gonzalez-Pagan said.

In response, AHCA lawyer Mohammad Omar Jazil told Hinkle that the rule allowed for some exceptions, including in some instances where a patient was pre-approved for treatment. Hinkle promised to note the exception for Rothstein’s surgery in the ruling that he said will be handed down soon.

Wednesday’s hearing included testimony from three witnesses brought by the state. One, New Jersey resident Yaakov Sheinfeld, testified that his 18-year-old daughter began transitioning at the recommendation of a therapist who determined her feelings of gender dysphoria, depression and anxiety could be treated with prescription hormones.

Gender dysphoria refers to the feelings of discomfort or distress some transgender people experience when their bodies don’t align with their gender.

Sheinfeld, who was recruited to testify by lawyers for AHCA, said his daughter’s anxiety and depression never went away, even after his daughter had gender-affirming surgery. She was later found dead in an East Orange, New Jersey, hotel room of a drug overdose.

“All I know is the system — the world, the Internet, her friends — informed her to take this journey,” Sheinfeld said, fighting back sobs. “And now she’s dead.”