LGBT groups sue over rule prohibiting gender-affirming treatment through Medicaid

Four LGBT and health advocacy groups filed a lawsuit on Wednesday against a Florida rule that prevents people from using Medicaid to pay for gender-affirming medical care. 

The rule from the state’s Agency for Health Care Administrators (AHCA), which went into effect last month, removed Medicaid coverage for puberty blockers, hormones and gender-affirming surgeries for transgender Floridians. 

A release from Lambda Legal, a civil rights organization that focuses on protecting LGBT rights and one of the groups involved in the lawsuit, stated that the AHCA ignored expert testimony and thousands of public comments opposing the rule during the public comment period of the process. 

The organizations filed the lawsuit on behalf of four transgender individuals, including August Dekker, a 28-year-old transgender man. 

Dekker said in a statement that the rule denies him access to treatment that he is not able to afford otherwise. He said everyone deserves to feel safe in their existence, but the ban will hurt transgender Medicaid beneficiaries’ physical and mental health. 

“It’s truly awful and unfair to feel like the state is targeting your existence,” Dekker said. 

Omar Gonzalez-Pagan, a counsel and health care strategist for Lambda Legal, said the rule is motivated by politics and bias instead of science. He said it ignores the AHCA’s mission to provide “Better Health Care for All Floridians.” 

Katy DeBriere, the legal director at the Florida Health Justice Project, another one of the groups involved in the suit, said the state is targeting low-income transgender individuals with the rule, which would continue health inequities by eliminating safe and reliable health care for some of Florida’s most marginalized residents. 

The groups filed the lawsuit against Simone Marstiller, the secretary of the AHCA, in her capacity leading the agency. 

Brock Juarez, the communications director for the ACHA, told The Hill in a statement that only treatments that are found to be safe and effective and meet "medical necessity criteria" are to be covered under the agency's rules.

"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," he said.

The agency completed a report on gender-affirming care in June at the request of the state health department, concluding that several services for treating gender dysphoria, like puberty blockers, hormones and surgery, are not consistent with "widely accepted professional medical standards."

The report also concluded that these treatments have the potential for harmful long-term effects and said that studies supporting these treatments are "weak to very weak."

The Lambda Legal release states that a team of legal and medical experts from Yale University and University of Texas Southwestern issued a report debunking claims in the AHCA's report. The team said the report makes "unfounded" criticism of robust research and cites sources with "little or no scientific merit."

The plaintiffs argue that the rule violates the equal protection clause of the 14th Amendment to the Constitution and the Affordable Care Act’s (ACA) protection against sex discrimination. 

They also argue it violates the Medicaid Act’s requirement for states to provide services to treat physical and mental health conditions and its requirement that eligible recipients receive the same amount of medical assistance as other recipients. 

The Department of Health and Human Services said in a statement on Wednesday that the rule likely violates Section 1557 of the ACA, which prohibits health programs that receive federal funding from discriminating based on sex and other characteristics. 

The department added that it plans to work to protect state Medicaid beneficiaries’ access to gender-affirming care.

This story was updated at 4:46 p.m.