A federal judge schedules a hearing on Florida's Medicaid transgender rule

With plaintiffs’ attorneys pointing to “an incredible chilling of the provision of care and access to care,” a federal judge has scheduled an Oct. 12 hearing in a lawsuit seeking to block a new state rule that prevents Medicaid reimbursements for gender-affirming treatment for minors and adults.

The Florida Agency for Health Care Administration, which largely oversees the Medicaid program, this summer proposed a rule to end reimbursements to medical providers for such treatments as puberty blockers, hormone therapy and gender-affirmation surgery.

After the rule went into effect on Aug. 21, Medicaid beneficiaries receiving gender-affirming treatment are responsible for paying the costs of services and medications, which can run to thousands of dollars per month.

Four plaintiffs, including two children, filed a lawsuit challenging the rule, alleging the treatment of gender dysphoria is “medically necessary, safe and effective” for transgender children and adults.

During a hearing Monday, U.S. District Judge Robert Hinkle asked one of the plaintiffs’ lawyers to elaborate on “the urgency on the ground” as the judge sought to set a date for hearing on the plaintiffs’ motion for a preliminary injunction. Lawyers for Gov. Ron DeSantis’ administration suggested the hearing should be held on Oct. 24.

“There are people being deprived of medications? You’re going to have to educate me on what treatment is provided, how often … what’s going to happen if I don’t do anything until Oct. 24? What’s the real-world impact going to be on people?” Hinkle asked.

“We have seen both an incredible chilling of the provision of care and access to care, given the lack of uncertainty on the ground,” Omar Gonzalez-Pagan, an attorney with Lambda Legal, told the judge. “That has permeated not just the care for our own clients but really all of those who are affected, the hundreds if not thousands of transgender beneficiaries affected by this rule.”

As an example, Gonzalez-Pagan pointed to one plaintiff who receives monthly prescriptions for testosterone “and has to, within the next few weeks, meet with his provider for a new prescription that would not be covered and he has no resources economically to be able to cover otherwise.”

Another plaintiff, Brit Rothstein, was scheduled to receive surgery in December, according to the legal complaint. But confirmation of the surgery is contingent on Rothstein’s ability to continue to have coverage for the procedure, Gonzalez-Pagan said Monday.

The federal government defines gender dysphoria as clinically “significant distress that a person may feel when sex or gender assigned at birth is not the same as their identity.”

If allowed to stand, the rule would have health effects in addition to financial impacts, Gonzalez-Pagan argued.

“Ultimately, the denial of access to this care means the exacerbation of their dysphoria, the development of physical characteristics incongruent with their identity, which then makes it harder to treat and/or resolve in the future, and exacerbates their anxiety and the attendant anxiety and depression and possibly even self-harm as the result of their dysphoria,” Gonzalez-Pagan said.

The rule “has disrupted what has been the status quo for years,” he added, after asking Hinkle to set a hearing the week of Oct. 11 on the preliminary-injunction motion.

Mohammad Jazil, an attorney with the Holtzman Vogel firm who represents the state, told Hinkle the defendants could be ready in time for a hearing the judge slated for Oct. 12.

Ceasing Medicaid reimbursements is among the moves the DeSantis administration is taking as the governor seeks reelection in November.

For example, a joint committee of the Florida Board of Medicine and the Florida Board of Osteopathic Medicine is scheduled to meet Sept. 30 to discuss a draft rule --- backed by the state Department of Health --- that could restrict doctors from providing treatments to transgender people under age 18.

The administration has defended the new Medicaid rule, relying in part on a report justifying the end of reimbursements.

The Agency for Health Care Administration “has done its due diligence” through the report and the rule-making process, agency spokesman Brock Juarez said in an email after the lawsuit was filed.

“These partisan motivated organizations 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. That is precisely what the agency has done here,” Juarez said in the Sept. 7 email.

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