The Biden administration this week urged an appeals court to uphold a ruling that Florida violated federal law by blocking Medicaid coverage for transgender people seeking hormone therapy and puberty blockers.
Lawyers from the U.S. Department of Justice and the U.S. Department of Health and Human Services filed a brief at the 11th U.S. Circuit Court of Appeals saying decisions by the state Agency for Health Care Administration and lawmakers to prevent coverage for the treatments violated a federal Medicaid law and the Affordable Care Act.
In part, the brief pointed to what it described as “nondiscrimination requirements” in the Affordable Care Act. It said “Florida’s (coverage) exclusions target transgender people and prevent them, because of their sex assigned at birth, from receiving care available to other Medicaid beneficiaries.”
As an example, the brief partially quoted a ruling by U.S. District Judge Robert Hinkle and said that under the state prohibitions “whether a Medicaid beneficiary can access a treatment such as testosterone depends on the patient’s sex assigned at birth. If the beneficiary is ‘a natal male, the treatment is covered.’ But if the beneficiary ‘is a natal female, the treatment is not covered.’”
Lawyers for the state went to the Atlanta-based appeals court in June after Hinkle found that the prohibition on Medicaid coverage for hormone therapy and puberty blockers violated the federal laws and the U.S. Constitution’s Equal Protection Clause.
The lawsuit was filed last year on behalf of two transgender adults and the parents of two minors after the Agency for Health Care Administration adopted a rule that barred the coverage. The lawsuit was updated this spring to include a new state law that similarly prevented coverage.
Gov. Ron DeSantis and many other Republican leaders across the country have made a priority in recent years of trying to restrict treatments for people with gender dysphoria. The federal government defines gender dysphoria clinically as “significant distress that a person may feel when sex or gender assigned at birth is not the same as their identity.”
In addition to this week’s brief by the Biden administration, the state’s appeal of Hinkle’s ruling has drawn briefs from states and organizations across the country. Republican attorneys general from 18 states signed on to a friend-of-the-court brief in October urging the appeals court to overturn Hinkle’s ruling; Democratic attorneys general from 19 states and the District of Columbia signed on to a brief this week backing the ruling.
The Medicaid coverage prohibition applied to minors and adults, but much of the debate in Florida and other states has focused on whether minors should be able to receive puberty blockers and hormone therapy.
In a brief filed in October at the appeals court, attorneys for the state wrote that the case is about “whether public funds should be used to reimburse for these treatments.”
“It’s a health and welfare question; it’s a medical policy issue,” the brief said. “It’s an area where the state gets to draw the line between what’s permissible and what isn’t. Here, the state of Florida made its decision in legislation … and an administrative rule. … It decided to deny Medicaid reimbursement for the treatments. That’s a decision the state gets to make. And given the evidence (or lack thereof) supporting the treatments, its decision was reasonable.”
But opponents of the prohibition have argued that many major medical organizations support making the treatments available. In his June ruling, Hinkle wrote that the state had no “rational basis to categorically ban these treatments or to exclude them from the state’s Medicaid coverage. The record includes no evidence that these treatments have caused substantial adverse clinical results in properly screened and treated patients.”
In addition to citing the Affordable Care Act, the Biden administration this week pointed to two parts of a federal Medicaid law: One part is known as the early and periodic screening, diagnostic and treatment services, or EPSDT, requirement; the other is known as a comparability requirement.
The EPSDT requirement involves coverage of certain care for Medicaid beneficiaries under age 21, while the comparability requirement is designed to ensure equal treatment of beneficiaries, the brief said.
The Biden administration attorneys wrote that “as the district court found, treating gender dysphoria with these medications remains consistent with widely accepted standards of care.”
“The district court correctly held, based on the trial record, that by categorically barring coverage for puberty blockers and hormone therapies when used to treat gender dysphoria, Florida violated Medicaid’s EPSDT and comparability requirements,” the 41-page brief, filed Monday, said.
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