Trans Health Care in Florida: What You Need to Know
On Friday, August 5, the Florida Board of Medicine ignored the warnings of medical experts and parents with transgender children and voted to adopt a “standard of care” that opposes gender-affirming care for trans youth — a move that would put the licenses of medical professionals at risk for providing life-saving care. This vote does not immediately impose restrictions on gender-affirming care, but does begin a regulatory process to do just that.
This is the latest in a coordinated attack on the health care needs of transgender youth and adolescents. Below you'll find an explanation of what is happening in Florida, what may happen next, and steps Florida residents can take to protect trans kids, their families, and their medical providers.
What did the Florida State Board of Medicine vote to do?
The Florida state Board of Medicine (BOM) is responsible for setting standards of care for all medical providers in Florida, and for enforcing their compliance with licensing and disciplinary review. Changing the standards of care requires (at a minimum) a formal rulemaking process under the Florida Administrative Procedure Act. On Friday, August 5, the board officially began the formal rulemaking process, which lasts up to 180 days and usually requires at least 90 days to complete, to consider proposed regulations that would restrict medically-necessary care for transgender youth. The proposed changes to state standards of care would do two things:
- Threaten medical providers with penalties or fines if they provide gender-affirming care to anyone under the age of 18 as treatment for .
- Impose waiting periods on adults seeking gender-affirming care and require adults to sign an informed consent form that includes disinformation about the risks of gender-affirming care.
What is gender-affirming care?
According to the U.S. Department of Health and Human Services, “Gender-affirming care is a supportive form of health care. It consists of an array of services that may include medical, surgical, mental health, and non-medical services for transgender and nonbinary people. For transgender and nonbinary children and adolescents, early gender-affirming care is crucial to overall health and well-being as it allows the child or adolescent to focus on social transitions and can increase their confidence while navigating the health care system.”
Gender-affirming care is a very individualized form of health care, and will look different for each person depending on their age, gender, and other physical and mental health needs. For prepubescent transgender youth, this care typically involves a “social transition” (changing clothes, hair, name, etc.) and never involves surgery or other irreversible medical treatments. During or after puberty, many transgender youth may receive reversible puberty blockers, hormone replacement therapy, or other medical interventions as overseen and prescribed by medical professionals. Some older transgender adolescents can and do access surgical care on a case-by-case basis as recommended by the World Professional Association of Transgender Health.
Gender-affirming care is widely recognized as the only evidence-based approach to addressing the health care needs of transgender youth, including severe mental health risks. For more:
- Health and Human Services:
- The Endocrine Society:
- American Academy of Pediatrics:
The medical community has already been very critical of Florida’s ongoing effort to ban gender-affirming care. In June, the Agency for Health Care Administration, which oversees Florida’s Medicaid program, published a report claiming the national standards of care for gender dysphoria are at odds with nationally accepted standards for Medicaid coverage. Medical and legal experts quickly condemned the proposed regulations as In April, the Florida Department of Health (DOH) issued a memo recommending against gender-affirming care for children and adolescents. Researchers cited in the memo by the surgeon general in an attempt to justify these restrictions , and denounced the proposed restrictions.
Three hundred Floridian health care providers who work with transgender youth then published an open letter in the Tampa Bay Times, . The guidance from the governor and surgeon general, the experts wrote, “misrepresents the weight of the evidence, does not allow for personalized patient and family-centered care, and would, if followed, lead to higher rates of youth depression and suicidality.”
Similar bans signed into law in Arkansas and are both blocked by federal courts.
What happens next?
The Florida State Board of Medicine vote was triggered by a “petition to initiate rulemaking” submitted to the board by the DOH at the behest of Surgeon General Joseph Ladapo, who heads the DOH. The move came at the direction of Gov. Ron DeSantis, who appoints the BOM’s members and has long pushed a broader .
Now that the board has initiated rulemaking, they will work internally to draft a proposed regulation, submit it for formal review, comments, and public hearing, and eventually publish a final rule. Once they publish their proposed regulation, they must accept public comments for 21 days, then hold a public hearing. After the hearing, they must wait at least 14 days to publish the final version of the regulation. Once the final regulation is published, it goes into effect 20 days later.
If the board does in fact make a final regulation to ban gender-affirming care for minors (or something even more expansive), it would likely go into effect in October or November of 2022.
What impact would this regulation have on providers of gender-affirming care in Florida?
If a final regulation is adopted and goes into effect (and is not enjoined by a court), that would mean any providers who continue to provide this care to minors would be subject to professional discipline by the BOM. Disciplinary proceedings can be initiated by public complaint and by the surgeon general’s staff directly. That discipline could lead to suspensions or revocations of medical licenses.
Most likely, that would mean all providers would voluntarily stop providing such care, health care insurance plans would proactively stop covering it, and malpractice insurers would impose higher premiums or drop coverage for gender-affirming providers even if they don’t treat minors or the population covered by the ban.
What can I do to stop it and ensure Floridians have access to gender-affirming care?
Once the BOM publishes its proposed rule to change the standard of care to ban gender-affirming care for minors, the board will be required to accept written comments from the public for 21 days starting on the day the proposed rule is published in the Florida Administrative Register. When the 21 days have concluded, a public hearing will be held by the board. Comments submitted by the public by email or written letter will be included in the official record of the BOM proceedings.
Members of the public can also attend the public hearing, although the number of individuals who can speak at the public hearing can be limited and will be controlled by the BOM. During a public hearing in July 2022 concerning the Medicaid rule changes, the Agency for Health Care Administration filled their speaker slots predominately with speakers who were hostile to gender-affirming care. If the BOM takes the same approach, it may be difficult or futile to attempt to make public comments at the hearing.
One of the most important things you can do is before the October 11 registration deadline and help elect lawmakers who will work to protect the rights of transgender youth, their families, and their health care providers.
In addition to engaging in the rulemaking process, you can make a difference by getting to know your neighbors and being a part of your local community. Gender-affirming care is not well understood by the public, and hostile groups spread disinformation to scare and misinform people about gender-affirming care and the transgender community. Being visible and participating in the local community may help the public recognize that gender-affirming care is not a danger to society and should be allowed like other medical care.
Learn More About the Issues on This Page
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Press ReleaseDec 2024
LGBTQ Rights
President Biden Must Veto Defense Bill Attacking Military Families with Transgender YouthPresident Biden Must Veto Defense Bill Attacking Military Families with Transgender Youth
WASHINGTON — The U.S. Senate today passed a version of the National Defense Authorization Act that would ban coverage for gender-affirming care for transgender youth whose parents are active-duty military personnel. The American Civil Liberties Union is opposing final passage of the defense bill over the inclusion of this health care ban and calling on President Joe Biden to veto the bill. Section 708 of the NDAA would prohibit insurance coverage for “medical interventions for the treatment of gender dysphoria” such as hormone therapy and puberty-suppressant medications, which Speaker Mike Johnson says would “permanently ban transgender medical treatment for minors.” The same treatments would be covered by TRICARE for any medical purpose other than treating gender dysphoria, the clinical diagnosis for the psychological distress experienced by transgender people related to their gender identity. “By passing this bill, the House and Senate are forcing thousands of active-duty service members to choose between their careers in the military and the future of their transgender children,” said Mike Zamore, national director of policy & government affairs at the ACLU. “This unconscionable and unjustifiable attack on those families stands in direct contrast to President Joe Biden’s legacy of defending the civil rights of transgender Americans — including when few in his own party showed the courage to do so. President Biden should cement his legacy by vetoing this bill and sending it back to Congress to pass without Speaker Johnson’s last minute health care ban for servicemembers’ kids.” If signed by President Biden, this health care ban would be the first new anti-LGBTQ provision enacted by Congress and signed into law by the president since the enactment of the military’s since-repealed “Don’t Ask, Don’t Tell” policy for LGBTQ servicemembers and the since-repealed federal law barring recognition of same-sex marriages known as the Defense of Marriage Act. It is unknown how many transgender youth are currently enrolled in TRICARE or how many of those enrolled are currently receiving coverage for gender-affirming care. In one 2022 analysis, 2,500 minor patients sought care for gender dysphoria through TRICARE Prime insurance at military or civilian treatment facilities in 2017, and 900 received puberty suppressants or gender-affirming hormones. Earlier this month, the Supreme Court heard oral arguments in a landmark case brought by the ACLU, the ACLU of Tennessee, Lambda Legal, and Akin Gump on behalf of three families and a medical provider challenging a Tennessee ban on gender-affirming hormonal therapies for transgender youth on the grounds the ban violates the Equal Protection Clause of the U.S. Constitution. -
Press ReleaseDec 2024
LGBTQ Rights
Montana Court Blocks State From Refusing to Correct Sex Markers on Transgender People's Birth Certificates and Driver's LicensesMontana Court Blocks State From Refusing to Correct Sex Markers on Transgender People's Birth Certificates and Driver's Licenses
HELENA, Mont. – A Montana court has granted a preliminary injunction preventing the state of Montana from enforcing policies that bar transgender people from obtaining accurate sex designations on their birth certificates and driver’s licenses. After a prior restriction on amendments of birth certificates was struck down by the courts, in early 2024 the state of Montana enacted a new rule that categorically bars transgender Montanans from correcting the sex designation on their birth certificates. Around the same time, the Montana Department of Justice adopted a policy similarly restricting amendment of driver’s licenses. The plaintiffs challenged these policies in state district court, arguing that they violate various constitutional provisions, including the right to equal protection of the law. In a recent Montana Supreme Court decision, two justices concluded that discrimination on the basis of transgender status – as the state is engaging in here – is a form of sex discrimination that violates the Montana Constitution’s equal protection clause. The plaintiffs, two transgender women, are represented by the American Civil Liberties Union, the ACLU of Montana, and Nixon Peabody LLP. Plaintiff Jessica Kalarchik, a veteran who served in the United States Army for 31 years, said: “After finally being able to live my life openly as the woman I know myself to be, I am frustrated that my birth state, Montana, wants me to carry around a birth certificate that incorrectly lists my sex as male. I live my life openly as a woman, I am treated as a woman in my daily life, and there is no reason I should be forced to carry a birth certificate that incorrectly identifies me as male. Fortunately, the court agrees that this ridiculous policy should not be in effect.” “Once again the State of Montana chose to adopt a draconian policy that is clearly intended to marginalize transgender Montanans, only for that discriminatory action to be blocked by the courts,” said Akilah Deernose, executive director for the ACLU of Montana. “Here in Montana we treasure our right to privacy and to live our lives free from governmental intrusion. The State of Montana clearly has not learned any lessons from the past few years, where courts have repeatedly struck down unconstitutional laws targeting transgender Montanans.” “Forcing anyone to carry documents that contradict their identity unjustly violates their rights to privacy, equal treatment, and not being compelled to convey a government message about their sex that they disagree with,” said Malita Picasso, staff attorney for the ACLU’s LGBTQ & HIV Project. “Such a policy marks transgender people for further mistreatment and discrimination, essentially requiring them to carry papers that out them as transgender any time they need to provide identity documents. Fortunately, the court has refused to allow the state of Montana to subvert the freedom of transgender Montanans to control their own identity as this case goes forward.” In granting the plaintiffs’ motion for a preliminary injunction, the court held, “[i]f the challenged state actions discriminate against transgender individuals on the basis of their transgender status, they also necessarily discriminate the basis of sex.” The state has the option of appealing the district court’s ruling to the Montana Supreme Court, but the underlying case will proceed in district court. A trial has not yet been scheduled. -
FloridaDec 2024
LGBTQ Rights
Keohane v. DixonKeohane v. Dixon
On September 30, 2024, the Florida Department of Corrections rescinded its policy regarding treatment of gender dysphoria, which allowed for hormone therapy when deemed medically necessary, as well as access to clothing and grooming standards that accord with one’s gender identity. Under this new policy, grooming and clothing accommodations have been stripped away, and hormone therapy is not permitted unless an exception is deemed constitutionally required. The ACLU brought a class action challenging the policy. -
IdahoDec 2024
LGBTQ Rights
Robinson v. LabradorRobinson v. Labrador
Two incarcerated transgender women have sued the state of Idaho alleging that HB 688, a 2024 law barring state funding for gender-affirming medical care for transgender people, denies them access to the health care their doctors have prescribed for them and is a violation of their Eighth Amendment right to be free from cruel and unusual punishment. They represent a class of all incarcerated folks within the state of Idaho who face the loss of hormone therapy due to HB 668.