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Trans Floridians sue to block Medicaid rule excluding gender-affirming care

Human rights groups are suing Florida on behalf of four Medicaid beneficiaries who have been denied coverage of their gender-affirming medical care under a new state rule.

Advocacy groups sued Wednesday to block a new Florida rule that bars Medicaid coverage of gender-affirming health care, such as puberty blockers, hormone therapy and surgery.

The Florida Agency for Health Care Administration adopted the rule last month after it issued a report that claimed gender-affirming procedures have the “potential for harmful long term affects.” The rule took effect Aug. 21. 

Four transgender Medicaid recipients in the state — two adults and two minors who are represented by their parents — said in Wednesday’s filing that the rule jeopardizes their abilities to access necessary medical care that they can’t afford out of pocket. 

August Dekker.
August Dekker.Courtesy August Dekker/Lambda Legal

One of the plaintiffs, August Dekker, 28, is a transgender man who lives north of Tampa. He said he has been receiving testosterone as treatment for his gender dysphoria, or the distress caused by a mismatch between someone’s gender identity and their assigned sex at birth, since 2017, according to the lawsuit, which advocacy groups filed in U.S. District Court for the Northern District of Florida.

Dekker has received Supplemental Security Income because of his disability, rheumatoid arthritis, since 2014, according to the suit. The monthly payment of $841 is his only source of income, which he uses to pay for rent, food and necessities. His hormone therapy, which would cost about $60 to $65 per month, has always been covered by Medicaid. 

On Wednesday, he said that he planned to pick up his testosterone prescription but that since the rule took effect, he was left scrambling to figure out how he is going to pay for it. 

“All these years Medicaid has covered my medication and treatment, and now all of a sudden my own state wants to deny me and other transgender Floridians access to care we need,” he said in a news conference.

He said that his family is able to cover the cost of his testosterone for this month but that they are also experiencing financial hardship, so he doesn’t want to burden them with the cost in the future. 

“I don’t want to lose the person that I have become, and I fear that losing access to this care will cause that,” he said.

Jade Ladue, the mother of a 12-year-old transgender boy who goes by K.F. in the lawsuit, said the new Medicaid rule will prevent her and her husband, Joshua, from being able to access puberty-blocking medication prescribed by K.F.’s doctors. 

“Our family income is very limited,” she said in Wednesday’s news conference. “We are appalled and stressed that we would not be able to afford the critical medication and treatment that has brought so much health, well-being and joy to our son. We are extremely worried about this and what would happen to him.”

The plaintiffs are represented by Lambda Legal, an LGBTQ legal advocacy group; Southern Legal Counsel, a public interest law firm in Florida; and Pillsbury Winthrop Shaw Pittman LLP, an international law firm. They are also represented by two health advocacy groups, the Florida Health Justice Project and the National Health Law Program.

The groups argue that Florida’s Medicaid rule violates the 14th Amendment’s equal protection clause and Section 1557 of the Affordable Care Act, which bars discrimination in federally funded health care institutions and programs, because it would cover puberty blockers and hormone therapy for cisgender people to treat other conditions. 

Simone Marstiller, the secretary of the Florida Agency for Health Care Administration, or AHCA, who is named as a defendant in the suit, didn’t immediately respond to a request for comment. 

In an email, Brock Juarez, the agency’s communication’s director, referred NBC News to the report the agency released in June about gender-affirming medical care and said that “the Agency has done its due diligence in both the AHCA report and the subsequent rulemaking process.” 

He referred to the groups suing the state as “partisan motivated organizations” that “seem to be so blinded by their own political agenda that they ignore the evidence found in our thorough rulemaking process and in the AHCA report that proceeded it.” 

“Under our rules, only treatments that are found to be safe, effective, and that meet medical necessity criteria may be covered,” he said. “That is precisely what the Agency has done here.”

The report Juarez referred to was prompted by guidance the state Health Department issued in April that sought to bar both “social gender transition” and gender-affirming medical care for people under 18 in the state. The guidance drew backlash from advocates and medical experts. Accredited medical groups — including the American Medical Association, the American Academy of Pediatrics and the American Psychological Association — say gender-affirming medical care is safe and medically necessary. 

Despite the backlash, the Florida Agency for Health Care Administration’s report “found that several services for the treatment of gender dysphoria — i.e., sex reassignment surgery, cross-sex hormones, and puberty blockers — are not consistent with widely accepted professional medical standards and are experimental and investigational with the potential for harmful long term affects.”

The lawsuit listed the state Health Department’s guidance in April and the Medicaid exclusion as part of “a series of measures the State has taken targeting transgender people, and LGBTQ people more broadly, for discrimination.”

Carl Charles, a senior attorney at Lambda Legal’s Southern Regional Office, said on Wednesday’s call that the exclusion is “without justification.” 

“Regardless of how the state tries to hide behind inaccurate data and doctors who have never once treated a transgender person masquerading as experts,” he said, “this exclusion flies in the face of Florida’s own policies and practices, which for decades now have included covering this care in the state Medicaid program without issue.”

Florida joined eight other states with Medicaid policies that explicitly bar coverage for gender-affirming medical care — a number that has been dropping over the years in part because of litigation and state laws that bar health care plans from excluding such coverage.

Just a day after Florida adopted its measure last month, a federal judge ruled that West Virginia’s Medicaid program couldn’t exclude coverage of gender-affirming surgery for program recipients. A federal judge in North Carolina issued a similar ruling in June. 

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