Florida challenges the feds on a new health care rule

medical worker
Medical worker. By gorodenkoff via iStock for WMNF News.

By Jim Saunders ©2024 The News Service of Florida

TALLAHASSEE — Florida has filed a lawsuit challenging a new federal health care rule, saying it clashes with the state’s efforts to restrict treatments such as hormone therapy and puberty blockers for transgender people.

The lawsuit, filed Monday in federal court in Tampa, targets a rule that affects programs such as Medicaid and the Children’s Health Insurance Program, which operates as KidCare in Florida.

The rule is designed to help carry out a law that prevents discrimination in health-care programs that receive federal money. The law prevents discrimination based on “sex,” and the rule includes discrimination based on gender identity and sexual orientation.

The lawsuit contends that the U.S. Department of Health and Human Services, through the rule, “purports to override the state of Florida’s laws and regulations protecting the health and safety of its residents.”

“HHS further threatens the loss of federal funds for states and insurance issuers that refuse to cover these interventions (such as hormone therapy and puberty blockers),” the lawsuit said. “Plaintiffs bring this action to stop HHS’s interference with the ethical practice of medicine and state police powers.”

But federal health officials said late last month the rule will help strengthen protections against discrimination.

In a statement, Department of Health and Human Services Secretary Xavier Becerra said the rule is a “giant step forward for this country toward a more equitable and inclusive health care system, and means that Americans across the country now have a clear way to act on their rights against discrimination when they go to the doctor, talk with their health plan, or engage with health programs run by HHS.”

Gov. Ron DeSantis’ administration and the Republican-controlled Legislature during the past two years have made a series of controversial decisions to prevent treatments for transgender people diagnosed with gender dysphoria.

That has included barring Medicaid coverage for treatments such as hormone therapy and puberty blockers. Also, the state has prevented doctors from providing such treatments to minors and put restrictions on the treatments for adults.

The decisions — which are similar to moves by Republican leaders in other states — have spurred a series of legal battles that continue to play out. The issue also has become high profile politically, with President Joe Biden’s administration pushing back against Republicans.

Florida Attorney General Ashley Moody, who is helping lead the lawsuit filed Monday, joined Alabama, Georgia and South Carolina last week in filing a case challenging a new Biden administration rule on sex-based discrimination in education programs. That lawsuit alleges, in part, that the Biden administration has overstepped its legal authority in extending regulations to apply to discrimination based on sexual orientation and gender identity.

Plaintiffs in the lawsuit filed Monday are the state, the Florida Agency for Health Care Administration, the Florida Department of Management Services and the Catholic Medical Association. The Agency for Health Care Administration runs the Medicaid program, which is jointly funded by the state and federal governments. The Department of Management Services oversees a massive health insurance program for state employees and retirees.

The new rule, which is slated to take effect July 5, is designed to carry out part of the federal Affordable Care Act prohibiting discrimination in health care services. But the state contends federal health officials have overstepped their authority, violating a law known as the Administrative Procedure Act.

“Under the (rule), Florida may not refuse reimbursement or coverage for gender-change interventions on the ground that they are ‘experimental’ and not medically necessary health care treatments,” the lawsuit said. “The (rule) would therefore require covering puberty blockers, cross-sex hormones, surgeries and related services to treat gender dysphoria under Florida Medicaid, CHIP (the Children’s Health Insurance Program) and other state programs … contrary to Florida law.”

The lawsuit also said that most medical providers, such as hospitals and clinics, accept federal money through Medicaid and other programs. It said the rule “will therefore force health care providers in Florida to choose between accepting federal funds and complying with Florida law regarding treatments for persons suffering from gender dysphoria.”

But the Department of Health and Human Services said in information posted on its website that the “rule does not require a specific standard of care or course of treatment for any individual, minor or adult. Providers do not have an affirmative obligation to offer any health care, including gender-affirming care, that they do not think is clinically appropriate or if religious freedom and conscience protections apply.”

The department, however, appeared to draw a distinction between decisions involving individual patients and broad policies about treatment.

“The final rule does not require those covered, including state Medicaid agencies, to cover a particular health service for the treatment of gender dysphoria for any individual, minor or adult,” the information on the website said. “Rather, it prohibits health insurance issuers, state Medicaid agencies, and other covered entities from excluding categories of services in a discriminatory way. Coverage must be provided in a neutral and nondiscriminatory manner.”

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