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Trans advocates criticize Florida rule that bans Medicaid from covering gender-affirming treatment

Daylina Miller
WUSF Public Media

Under the rule, which goes into effect Aug. 21, Medicaid would not cover puberty-blocking meds, hormones and hormone “antagonists,” gender-affirmation surgeries and “other procedures that alter primary or secondary sexual characteristics.”

On Aug. 1, the state Agency for Health Care Administration quietly finalized a rule that bans Medicaid from covering gender-affirming care for many poor and disabled transgender people.

Under the rule, which goes into effect Aug. 21, Medicaid would not cover puberty-blocking meds, hormones and hormone “antagonists,” gender-affirmation surgeries and “other procedures that alter primary or secondary sexual characteristics.”

The rule states these treatments "do not meet the definition of medical necessity" in accordance with Florida Administrative Code.

A state report says the Medicaid program “has determined that the research supporting sex reassignment treatment is insufficient to demonstrate efficacy and safety.”

In a statement, AHCA Secretary Simone Marstiller said “we have seen a dangerous mix of politics and medicine from doctors in the Biden administration and many of our medical societies across the United States. It is imperative for states like Florida to step up and ensure our focus remains on the actual evidence, rather than the eminence of a medical society or association.”

The rule was published Wednesday by AHCA, which manages the state's Medicaid program, a federal health care plan for low-income families and individuals, the elderly, and people with disabilities.

A week earlier, the Florida Board of Medicine advanced an AHCA plan that would ban doctors from providing such treatments to people under age 18. That decision came after the Florida Department of Health filed a petition asking the board to initiate a rule-making process on the contentious issue.

Carl Charles, a senior attorney with Lambda Legal, which has been fighting a legal battle against the plan, said the state's arguments are flawed.

“The state Department of Health went out of its way to produce a 40-page memo that contains a lot of misinformation about the available data. It cites two ‘experts’ who do not actually treat transgender people, but were cherry picked for their oppositional views to this care."

He accuses AHCA for ignoring “thousands of comments” from people opposed to the rule, and said a public hearing about the rule in July involved “inflammatory talking points” and mistruths about sterilizing surgeries for children.

“Let me be incredibly clear, children are not experiencing any kind of surgery, right? That is not indicated for them,” Charles said. “At most, if medically appropriate, and monitored by doctors and other professionals, some trans children do access puberty delaying medication.”

And those puberty blockers are reversible. But for most children, transition means a haircut and a change of clothes, new pronouns and potentially a new name.

Seven scientists and a Yale law professor have countered with a report that said the state study’s “conclusions are incorrect and scientifically unfounded.”

Nikole Parker is a transgender woman, and the director of Transgender Equality for Equality Florida. She said decades of research supports gender-affirming care.

"I transitioned some years ago, and the fact that I was able to access gender affirming care is the only reason that I'm alive today. And the fact that they are removing it from trans individuals that are on Medicaid is going to be astronomically horrendous. For our community, it is going to cause increased rates of depression, suicide.

She said the decision was entirely political, and not based in science.

“We should leave the politics out of it,” Parker said. “And we should let medical professionals who see trans people every day, who provide this care and know exactly what it does and how it is, in fact, lifesaving, we should let those folks take the lead instead of politicians coming in and wanting to just demonize the trans community to garner votes.”

Lambda Legal, Southern Legal Counsel, Florida Health Justice Project, and National Health Law Program issued a statement vowing to fight the rule, and while they would not comment on specific, lawsuits could be next.

They encourage any transgender person, who is a Medicaid participant in Florida and is at risk of losing Medicaid coverage for their gender-affirming health care to share their story at or reach out to: 

Health News Florida producer Rick Mayer contributed to this report.

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Daylina Miller is a multimedia reporter for WUSF and Health News Florida, covering health in the Tampa Bay area and across the state.