August Dekker was thrilled to join a beach party without wearing a shirt this summer, feeling like himself, in public, for the first time.
The 28-year-old transgender man obtained a medically necessary chest surgery in April, as reccomended by his team of doctors, following treatment for his gender dysphoria.
But under recently enacted rules in Florida, Mr Dekker and thousands of other transgender residents in the state who rely on Medicaid for their healthcare will no longer be allowed to access coverage for gender-affirming treatment through the government healthcare programme for low-income people.
He is among a group of four transgender residents and their families suing the state in federal court to block the policy, arguing that the state’s changes to Medicaid rules amount to unconstitutional discrimination that denies them treatment solely on the basis of their gender identity.
For Mr Dekker, the beach party “was an afternoon full of joy and laughter” and “he had never felt more euphoric about his body than he did in that moment,” according to the lawsuit. But now he is among thousands of transgender patients scrambling to find ways to afford the potentially life-saving care on which they have relied.
“This exlusion is discrimination, plain and simple,” according to Carl Charles, a senior attorney with Lambda Legal, among several civil rights groups representing the plaintiffs.
Roughly 9,000 Florida residents are receiving gender-affirming care through Medicaid. The state’s new exclusion rule “threatens to make living in the state as a Medicaid beneficiary simply impossible” for transgender people, Mr Charles told reporters on 7 September.
Mr Dekker also relies on testosterone hormone therapy to treat his gender dyspohria as prescribed monthly by his medical and mental health providers, which have been covered through Medicaid – until last month.
He no longer feels safe being an out transgender man in the state, according to the lawsuit. He fears having to scramble to access his prescribed medication on his limited income, and he worries about debilitating stress and the physical effects of losing access to care.
“Everyone deserves to exist in a way that feels safe, yet this ban will impact so many transgender Medicaid beneficiaries like me with very negative effects on our physical and mental health and our lives,” he said in a statement.
Brit Rothstein came out to his mother in 2016. She called him an “abomination” and disowned him, according to the lawsuit.
The 20-year-old transgender man received treatment from a pediatric endocrinologist who determined that it was medically necessary to begin a regimen of hormone blockers, followed by testosterone hormone therapy, to treat his gender dysphoria.
Medicaid has covered his gender-affirming treatment, including therapy, blood tests, office visits, and his prescriptions for hormone blockers and testosterone, according to the lawsuit.
The University of Central Florida junior is scheduled to undergo a chest surgery in December 2022, after wearing uncomfortable chest binders every day for up to 12 hours a day.
“When Brit received his pre-authorization on [11 August], he felt blessed to finally have the chance to obtain the gender-affirming care he needed,” the lawsuit states. “The surgery would allow Brit to bring his body into alignment with who he is.”
The next day, the Medicaid exclusion rule was adopted, a “punch in the gut” and the “lowest of lows” for Mr Rothstein, whose limited annual income and ineligibility for coverage under new Medicaid rules will likely make access to prescriptions and surgery unaffordable, according to the lawsuit.
Florida is now among nine states that deny Medicaid coverage for gender-affirming care.
In June, Florida’s Agency for Health Care Administration released a 46-page report citing widely debunked research seeking to justify gender-affirming healthcare coverage for Medicaid recipients.
The report falsely claimed that such treatment is “not consistent with widely accepted professional medical standards” and amounts to “experimental and investigational with the potential for harmful long term [effects].”
LGBT+ legal groups also have pointed out that under the rule, certain procedures that are not covered for trans Medicaid recipients are still covered for cisgender people who require the same treatment.
“The state’s disingenuous position that the same prescription services and procedures are somehow unsafe and ineffective only when provided to trans people should be seen for what it is: playing politics with people’s health care and well being,” civil rights attorney Simone Chriss with the Transgender Rights Initiative at Florida’s Southern Legal Counsel told reporters.
The state “has chosen to ignore the evidence, the science, and the consensus of medical professionals in a shameful effort to gain political points,” she said in a statement.
A spokesperson for the Agency for Health Care Administration, the Florida agency named in the lawsuit, said in a statement to news outlets that “only treatments that are found to be safe, effective, and that meet medical necessity criteria may be covered” under the Medicaid rules. “That is precisely what the Agency has done here.”
The lawsuit comes as state lawmakers across the US draft other restrictions impacting transgender people, amid a growingly volatile political landscape around LGBT+ rights and healthcare, with increasing reports of abuse and harrassment and threats of violence.
Florida’s Medicaid rule was adopted as state health officials also consider new rules proposed by Governor Ron DeSantis’s administration that would deny all gender-affirming treatment for trans youth, including “social” transitioning measures like changing pronouns or wearing different clothes.
Leading medical groups including the American Medical Association, American Academy of Child and Adolescent Psychiatry, the American Academy of Pediatrics and the American Academy of Family Physicians, among others, have established evidence-based clinical guidelines to treat trans youth, while warning that denying such care will lead to higher rates of suicide, depression and other poor health outcomes.
In April, 300 medical providers in the state also wrote a letter published in the Tampa Bay Times that criticises a state memo advising doctors against providing gender-affirming care to minors.
Jade Ladue is the parent of a 12-year-old transgender boy, named in the lawsuit as KF.
KF “loves sports, basketball – your typical, everyday neighborhood kid,” Ms Ladue told reporters on 7 September.
The family’s medical team determined that it is medically necessary for KF to receive puberty-delaying medication to treat his gender dysphoria – treatment that will have to be entirely out of pocket under new Medicaid exclusion rules.
After starting a treatment plan, KF has “had a smile on his face, a light in his eye, and even a glow about him,” and his school performance and relationships have also improved, according to the lawsuit.
Without Medicaid coverage, monthly treatments could “cost between $1,000 to $2,000” each, according to the lawsuit. The family is worried they will not be able to keep up with the treatments on their limited incomes.
KF’s parents are “incredibly worried about the potential physical and mental health consequences” of losing access to care, and “can only assume that reversing that course of treatment would result in the unthinkable happening.”
“We are in this lawsuit … because as any other parent, we want the best for our child,” Ms Ladue told reporters.
