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A new lawsuit is challenging Florida Medicaid's exclusion of transgender health care

LGBTQ activists and their supporters rally in support of transgender people on the steps of City Hall in New York, NY on October 24, 2018.
Drew Angerer/Getty Images
LGBTQ activists and their supporters rally in support of transgender people on the steps of City Hall in New York, NY on October 24, 2018.

A new federal lawsuit has challenged the state of Florida's effort to exclude gender-affirming health care for transgender people from its state Medicaid program, calling the rule illegal, discriminatory and a "dangerous governmental action."

A coalition of legal groups filed the lawsuit Wednesday on behalf of four Florida Medicaid recipients, who are either transgender or parents of transgender youth, in the Northern District of Florida.

"This exclusion is discrimination, plain and simple," said Carl Charles, a senior attorney for Lambda Legal, a LGBTQ civil rights organization that is leading the lawsuit and has litigated similar issues around the country. "Transgender Medicaid beneficiaries deserve health care coverage free from discrimination, just like any other Medicaid beneficiary in Florida."

One of the lawsuit's four plaintiffs, a 20-year-old transgender man named Brit Rothstein, was pre-authorized by Florida's Medicaid program on Aug. 11 for a chest surgery that was scheduled for December, the complaint states.

The next day, the lawsuit says, Rothstein learned that Florida had decided to strip Medicaid coverage for the procedure.

Jade Ladue, another plaintiff, said she and her husband began seeking medical care for her son, who is identified in the lawsuit as K.F., after he came out as transgender at 7 years old.

K.F.'s doctor recommended puberty blockers, a common treatment for transgender youth that helps delay the effects of puberty, which he then received via an implant. Due to Ladue's limited family income, the lawsuit states, the costs were covered under Medicaid.

In the future, K.F. could need monthly shots that could cost more than $1,000 out of pocket, the lawsuit states. "For our family, it would be super stressful," Ladue said. "Potentially, if it's something we couldn't afford, we'd have to look to possibly moving out of state."

About 5 million Floridians — nearly a quarter of the state's residents — rely on the state's taxpayer-funded Medicaid program. More than half of the children in the state are covered by Medicaid, and most adult recipients are either low-income parents or people with disabilities.

For years, the program has covered the cost of gender-affirming health care for transgender people, including hormone prescriptions and surgeries. Advocacy groups estimate that 9,000 transgender people in Florida currently use Medicaid for their treatments.

In June, the state's Medicaid regulator, the Florida Agency for Health Care Administration, issued a report claiming that health care for gender dysphoria – the medical term for the feelings of unease caused by a mismatch between gender identity and sex as assigned at birth – is "experimental and investigational" and that studies showing a benefit to mental health are "very low quality and rely on unreliable methods." The state's report has been criticized by medical experts.

Then, last month, the agency implemented a new rule banning health care providers from billing the Medicaid program for such treatments for transgender patients. Those treatments are still covered for patients who are not transgender, the lawsuit says. (For example, cisgender children may be prescribed hormone blockers for a condition called "precocious puberty," in which the body begins puberty too early.)

The abrupt end to Medicaid coverage "will have immediate dire physical, emotional, and psychological consequences for transgender Medicaid beneficiaries," the complaint says. Challengers have asked for the rule to be permanently enjoined.

A handful of other states have similar exclusions. Lambda Legal has filed challenges in several, including Alaska and West Virginia, where a federal judge ruled in August that the state's Medicaid agency could not exclude transgender health care from coverage.

Copyright 2022 NPR. To see more, visit https://www.npr.org.

Becky Sullivan
Becky Sullivan has reported and produced for NPR since 2011 with a focus on hard news and breaking stories. She has been on the ground to cover natural disasters, disease outbreaks, elections and protests, delivering stories to both broadcast and digital platforms.