Florida defies federal judge in blocking transgender care, new court filing claims

A group of transgender plaintiffs says Florida is violating a federal judge’s order by continuing to prohibit Medicaid coverage of treatments for gender dysphoria.

In a motion filed Wednesday in the Northern District of Florida, the plaintiffs say the state’s Agency for Health Care Administration is in “complete defiance” of U.S. District Judge Robert Hinkle’s June ruling, which said the state’s Medicaid ban was “invalid” to the extent that it categorically banned Medicaid payment for treatments of gender dysphoria. They are asking Hinkle to enforce or clarify his ruling.

They point to instances where transgender Medicaid recipients were denied coverage for hormone therapy after the June ruling and comments from the agency’s secretary warning of possible further action against Medicaid providers for violations of the state’s rule.

The state has appealed Hinkle’s ruling. The Court of Appeals for the Eleventh Circuit has not paused the lower court’s judgment, so it remains in effect as the appeal continues.

“Defendants have thus acted as if this Court’s decision is a legal nullity that they can simply ignore on their whim,” the motion says. “That is not how our legal system works, however.”

READ MORE: Judge rules Florida ban on Medicaid payments for transgender care is unconstitutional

The motion notes that the agency in August fined five Medicaid providers for covering treatments including a minor’s double mastectomy, hormone therapy and puberty blockers.

The fines were for treatments covered from December 2022 to February 2023, when the rule was in place.

But the plaintiffs’ motion says that letters the agency sent to the healthcare groups direct them to cease and desist from further violations of the rule.

In those letters, the agency asks the Medicaid groups to confirm in writing that they have “ceased coverage of the services” for the treatment of gender dysphoria.

Agency Secretary Jason Weida announced the fines on a conservative Daily Wire podcast. During that podcast, he said there is “a range of more drastic penalties that we can take, and we’re going to look into taking those if we continue to see this type of action.”

“We think that the protection of children is one of the most core functions of government, and here in Florida we’re going to do everything that we can, I’m certainly going to do everything I can, I know the governor is going to do everything he can, to protect children from these types of mutilations,” Weida said in the podcast.

READ MORE: Florida deviated from standard practices for key report regarding transgender care

Wednesday’s motion also refers to an email thread between a Herald/Times reporter and an agency spokesperson in August in response to questions about the fines.

In one email, spokesperson Bailey Smith said the agency was complying with the court’s order, and that the rule “continues being in effect within the parameters outlined by the District Court.”

When asked specifically what parts of the rule were still in place, Smith said that surgeries are prohibited across the board and said “the rest of the rule can’t serve as a categorical ban. It isn’t one.”

Court records show that an Agency for Health Care employee, who was the lead author on the report that led to the Medicaid exclusion, previously called the state’s rule a categorical exclusion in testimony taken in February.

The Agency for Health Care Administration did not respond to a request for comment Thursday about the plaintiffs’ motion.

The motion also points to an August email sent to University of Miami physicians, informing them about the Medicaid rule, and saying their office has “been compelled” to refund any Medicaid reimbursement for treatment of gender dysphoria. The email asks physicians not to bill Medicaid or Medicaid plans for any related services “for the foreseeable future.”

Lydia Fein, who leads the transgender health program at the University of Miami, said she has had to cancel all appointments for transgender patients who receive their coverage through Medicaid and that it is causing harm to her patients, according to her declaration.