Rights Behind the Headlines: Florida Wants to Deny Lifesaving Healthcare to Transgender Floridians

Rights Behind the Headlines is a new blog series from the ACLU of Florida that dispels misinformation and gives Floridians critical information about the most pressing issues facing our state. Read the full series at aclufl.org/rightsbehindtheheadlines  

In June, Gov. DeSantis said that Medicaid should no longer cover gender-affirming healthcare for transgender Floridians. Today, we’re exposing the harm and impact that both this new rule from the Florida Agency for Health Care Administration and a potential change by the Florida Board of Medicine to the standards of care for gender-affirming treatment would have on transgender Floridians’ ability to access essential and life-saving healthcare. Read the headline from CBS News here: Florida moves forward on denying transgender treatments.

Transgender people have always struggled for basic recognition of their human rights. In Florida, that battle has included the right for youth to play sports and access lifesaving and critical healthcare. 

At a press conference June 2, Gov. Ron DeSantis said that Florida should deny Medicaid coverage for treatments such as puberty-blocking medication and hormone therapy for transgender people. The Florida Agency for Health Care Administration (AHCA), which runs most of Florida’s Medicaid program, then proposed a rule that would deny coverage for all medically-necessary gender-affirming care for Medicaid recipients. That proposed rule was subsequently adopted by AHCA and went into effect on August 21, 2022. 

The AHCA adopted the discriminatory Medicaid exclusion despite the evidence-based guidance from medical experts and medical associations supporting gender-affirming care. All major medical associations accept these standards of care. Medical providers have safely used these medications and treatment methods for decades for many medical conditions, including gender dysphoria. The drastic changes to Medicaid coverage are a baseless attack on lifesaving medical care in violation of federal law.

The discriminatory new Medicaid rules claim to establish that such treatments don't meet a definition of "medical necessity." That is important because, by law, services provided in the Medicaid program must be deemed medically necessary. This attempt to define medical necessity for the treatment for all transgender people conflicts with Florida statutory law that requires the AHCA to make determinations of medical necessity in consultation with medical providers at the time care is being given.

The American Medical Association has publicly opposed political interference by the government in healthcare decisions for transgender people, including in the case of adolescents. "We believe it is inappropriate and harmful for any state to legislatively dictate that certain transition-related services are never appropriate and limit the range of options physicians and families may consider when making decisions for pediatric patients," the organization stated in April 2021.

In September, Lamba Legal, Southern Legal Counsel, Florida Health Justice Project, National Health Law Program, and Pillsbury Winthrop Shaw Pittman LLP, filed a federal lawsuit to challeng Florida’s anti-transgender health care rule denying medically necessary gender-affirming medical care to Medicaid recipients. 

In addition to the Florida AHCA’s anti-trans healthcare attack, in August, the Florida Board of Medicine voted to begin the rulemaking process to adopt a new “standard of care” that would prohibit gender-affirming care for trans youth. This Board of Medicine rulemaking process is ongoing, and the language of a proposed rule has not yet been published. If the Board of Medicine does in fact adopt a new standard of care prohibiting gender-affirming care for minors in Florida, medical professionals who provide this life-saving care would put their medical licenses at risk.

Gender-affirming care is widely recognized as the only evidence-based approach to addressing the health care needs of transgender youth, including severe mental health risks. The medical community has already been very critical of Florida’s ongoing effort to ban gender-affirming care, including more than three hundred Florida health care providers who work with transgender youth who published an open letter in the Tampa Bay Times condemning the proposed regulations.

The course of action taken by Florida state agencies at the direction of Gov. DeSantis and Florida Surgeon General Joseph Ladapo is life-threatening discrimination, pure and simple. Florida joins other extremist states that have passed anti-trans healthcare laws that will have a dangerous impact on transgender people. This is yet another instance of state officials countermanding medical and scientific expertise for purely political purposes and creating human suffering as a byproduct.