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Judge Blocks FL’s Ban on Gender-Affirming Care for Trans Residents on Medicaid

The ban on gender-affirming care for trans Medicaid patients wasn't a "fair analysis of the evidence," the judge said.

People participate in the Drag March for Trans Rights at Rich's on June 18, 2023, in San Diego, California.

A federal judge in Florida has overturned a state law and executive branch administrative action that barred the use of Medicaid funds to pay for gender-affirming health care for transgender residents.

The ruling, issued by U.S. District Judge Robert Hinkle on Wednesday, was largely expected, given that Hinkle had ruled similarly in a case earlier this month that focused on gender-affirming health care for trans youth in Florida, finding the state’s actions to be discriminatory and transphobic.

Hinkle’s ruling in that case was far more narrow, applying to specific litigants rather than overturning state law altogether, though it may result in a more expansive outcome in the near future. The judge’s latest ruling this week, however, affects all transgender people in the state who receive benefits from the state Medicaid program.

Around 9,000 transgender Floridians are currently enrolled in Medicaid.

The case involved these individuals being denied gender-affirming care — treatment that health care professionals and dozens of medical organizations agree is safe and often life-saving. Notably, Florida’s state health agency, charged with overseeing health care regulations, had initially approved requests from transgender adults on the state Medicaid program to receive gender-affirming treatments from their doctors. But the agency reversed course in response to a directive from Gov. Ron DeSantis (R), who told officials that they had to review their standards.

After doing so, the agency opted to ban Medicaid disbursements for gender-affirming care.

Hinkle was direct in his ruling, stating affirmatively that “gender identity is real,” and that, like his previous decision on gender-affirming care, the Medicaid ban in Florida was based on transphobic attitudes of state lawmakers.

The agency’s shift from allowing Medicaid funds to be used to suddenly revoking the funds was “a biased effort to justify a predetermined outcome,” Hinkle said, “not a fair analysis of the evidence” to justify barring care to transgender recipients.

Hinkle also described that change as a “well-choreographed public hearing that was an effort not to gather facts but to support the predetermined outcome.”

The state failed to express a “legitimate” interest in implementing the ban, and engaged in “purposeful discrimination” against transgender people, the judge went on.

“There is no rational basis for a state to categorically ban these treatments or exclude them from the state’s Medicaid coverage,” Hinkle said in his ruling.

Several states across the country have sought to restrict gender-affirming care despite its potential to be life-saving for those who need it. Bans implemented by right-wing lawmakers have largely focused on children, but some have also targeted the treatment of trans adults.

Although many of these bans remain in place, several states — including Alabama, Arkansas, Indiana and Oklahoma — have had such restrictions overturned by federal judges. In Arkansas, a judge found that the ban against children receiving treatments was a violation of parents’ and kids’ rights under the 14th Amendment’s Equal Protection Clause. (Hinkle cited a similar rationale in his ruling this week that the Medicaid ban in Florida was unconstitutional.)

LGBTQ advocates celebrated Hinkle’s decision.

“This ruling affirms what we’ve known: the DeSantis Administration’s rule was politically motivated, denying access to care is against the overwhelming weight of medical authority, and there is no rational basis for a state to ban such care or exclude it from Medicaid coverage,” a tweet from Equality Florida said.

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