Orlando, FL — A coalition of legal groups sued Florida’s Agency for Healthcare Administration (AHCA) over a rule that went into effect in August that bars health care providers from billing Medicaid for treating gender dysphoria.

The lawsuit, Dekker, et al., v. Marstiller, et al., was filed in the U.S. District Court in the Northern District of Florida, and alleges that the AHCA rule violates the Medicaid Act and the Affordable Care Act.

According to a 2019 study by the University of California, Los Angeles (UCLA), about 9,000 trans adults in Florida are enrolled in Medicaid.

As of Aug. 21, that group lost coverage for treatments including hormone replacement therapy and “any other procedures that alter primary or secondary sexual characteristics,” per the AHCA rule.

The new lawsuit alleges that by blocking Medicaid from covering treatments for gender dysphoria, the rule discriminates on the basis of sex and violates the Affordable Care Act.

Mayo Clinic describes gender dysphoria as “​​the feeling of discomfort or distress that might occur in people whose gender identity differs from their sex assigned at birth or sex-related physical characteristics.” The August ban specifically applies to transgender people seeking gender-affirming care: The rule does not apply to treatments like breast reconstruction for cancer patients following a mastectomy.

Alyssa MacKenzie, who sits on the board of the LGBTQ caucus of the Seminole County Democratic Party, describes the rule as “the most serious threat that has faced trans people in the state.”

MacKenzie, who is trans, says hormone replacement therapy — also known as HRT — dramatically improved her quality of life.

“It’s helped me find a peace with myself that I never had,” she said. “I’m 42. I was 39 when I started, and that’s a long time to not be OK with yourself.”

MacKenzie recently switched jobs, and no longer has employer-based health insurance. Without help from the state, she will cover the cost of her treatment independently.

Groups like the American Medical Association and the American Academy of Pediatrics support gender affirming health care for trans people, citing research that shows this kind of care can reduce rates of depression among trans patients, who are already at heightened risk for suicide.

In an email to Spectrum News, AHCH communications director Brock Juarez described opposition to the rule as “clearly coming from unscientific and partisan motivated organizations” and claimed evidence for the benefits of hormone replacement therapies as “very weak.”

“Our main focus has always been on the actual evidence, rather than the eminence of a medical society or association,” wrote Juarez. “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.”

Meanwhile, the Florida Board of Medicine has also advanced a rule-making process to prevent health care providers from administering gender-affirming care to youths in the state.

Gov. Ron DeSantis has concurrently campaigned against gender-affirming care for minors, claiming at a press conference on Aug. 4, that doctors in the state “are literally chopping off the private parts of young kids.”

Researchers with PolitiFact subsequently found no examples of young children receiving transition-related surgeries in the state.

The move to restrict access to gender-affirming health care options for trans people has been replicated around the country in various forms. This April, for example, the state of Alabama passed a law criminalizing gender-affirming treatments for minors. A temporary injunction has blocked parts of the bill, which made it a felony to provide gender-affirming care to younger patients.

Experts say that whether that ban holds up in court could be a bellwether of the viability of such laws.