TALLAHASSEE — The Biden administration is urging 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.”
Lawyers for the state went to the Atlanta-based appeals court in June after U.S. District Judge Robert 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 transgender 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 it a priority in recent years to restrict treatments for transgender 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.”
But opponents of the prohibition have argued that many major medical organizations support making the treatments available. In his 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.”
