Florida Moving toward Medicaid Ban on Gender-Affirming Care for Transgender People

The state Agency for Healthcare Administration has proposed a rule declaring that Florida Medicaid does not cover puberty blockers, hormones and hormone antagonists, sex reassignment surgeries, and “any other procedures that alter primary or secondary sexual characteristics.”

The proposed rule comes at a time when transgender and gender-nonconforming people complain of growing animosity from the state government, from the Legislature to administrative agencies.

Gov. Ron DeSantis is firmly behind these moves. He has openly mocked transgender swimmer Lia Thomas’ March championship in the NCAA women’s 500-yard freestyle competition as an example of a narrative the left wing is trying to impose about gender identity.




“And then they give that [emphasis added] the national championship over these women who’ve been training for a long time,” DeSantis said on May 18.

During a Friday afternoon AHCA meeting, the rule was up for public comments. A majority of speakers spoke in support of the rule, claiming it would protect children from “unproven” medical procedures.

Those against the rule declared it discriminatory to transgender individuals.

Cheers, heckling

Following two hours of public comment during the afternoon into the evening, the panel took no vote on the proposed rule, pending closure of the public-comment window on Monday.

Despite the fact that the rule bans all Medicaid coverage for gender-affirming care to treat gender dysphoria, many of the public comments in support of the rule banning gender-affirming care spoke about “protecting children.”

January Littlejohn, a Leon County parent who regularly shares her story that the Leon County School District let her child socially transition without Littlejohn’s consent, was one of them.

“Unfortunately, gender dysphoric children are being encouraged, through activism and peer pressure, to disassociate from their bodies and to believe that their body parts can be removed and modified or replaced,” she said.

News organizations have reported that Littlejohn had been fully in communication with the school and gave permission for her child to use her preferred name while in the classroom. She later sued the school board, alleging she had been denied information about the situation.

Speakers in support of the rule drew cheers, applause, and audible ‘yes’ and ‘amen’ in agreement. Those speaking the against the rule got heckled.

That was the case for Sabrina Hartsfield, a student at the University of Kentucky and a Tallahassee native.

“Without gender-affirming health care, transgender and gender non-conforming individuals will die,” Hartsfield said. “According to every major, legitimate medical organization, gender-affirming care is the treatment for gender dysphoria.”

Yet ACHA argues some gender-affirming care, including hormones, puberty blockers, and surgeries affecting secondary sex characteristics, may not meet the “generally accepted professional medical standards” for treatment of gender dysphoria and therefore should not be funded under Medicaid.




Lakey Love, an advocate with the Florida Coalition for Transgender Liberation, told the Phoenix that the proposed rule will “promote systemic transphobia by denying best practice medical care for over 9,000 transgender and gender non-conforming people in Florida.”

Lifesaving care

“It’s lifesaving, science-based medical care,” Love stressed, noting that many of the procedures and treatments such as hormone therapies are used by cisgender people regularly.

Jon Harris Maurer, public policy director with LGBTQ+ advocacy group Equality Florida, told the Phoenix that the proposed rule is “part of a concerted effort opposing transgender equality that we saw start in the Legislature and is now filtering through state agencies.”

The Florida Policy Institute, a nonprofit and nonpartisan organization that promotes economic mobility, claimed that the rule could be discriminatory.

“AHCA’s proposal would bar transgender patients from accessing essential care and reverse current Medicaid policies that have been in effect for years,” according to a written statement Friday.

“Not only does denying gender-affirming treatment run counter to mainstream medical standards of care — it’s also inconsistent with multiple federal antidiscrimination laws, including a specific prohibition on states from arbitrarily denying or reducing Medicaid services solely because of ‘diagnosis, type of illness or disability.’”

According to a 2019 report called “Medicaid Coverage for Gender-Affirming Care” from the Williams Institute at the UCLA School of Law, states differ on whether Medicaid covers gender-affirming care — some explicitly cover it while others don’t. Some lack explicit language one way or another.

In its report, the Williams Institute said that some 9,000 transgender individuals in Florida have enrolled in Medicaid. But LGBTQ+ advocates such as Love suspect that that number may be higher.