Florida Medicaid does not cover gender-affirming care for the treatment of gender dysphoria. Puberty blockers, hormone therapy, hormone antagonists, sex reassignment surgeries, and any other procedures intended to alter primary or secondary sexual characteristics are excluded from coverage, whether the recipient is a minor or an adult. Mental health services remain covered, and you have the right to appeal any denial.
Treatments Florida Medicaid Will Not Pay For
The exclusion is written broadly. None of Florida’s Medicaid managed care plans may use state funds to pay for the following when prescribed for gender dysphoria:
- Puberty blockers used to pause or delay puberty in minors
- Hormones and hormone antagonists, including estrogen and testosterone prescribed for gender transition
- Sex reassignment surgeries, including genital reconstruction, chest surgeries, facial feminization, and voice modification procedures
- Any other procedures that alter primary or secondary sexual characteristics for the purpose of treating gender dysphoria1Legal Information Institute. Florida Administrative Code Ann. R. 59G-1.050 – General Medicaid Policy
That fourth category is a catch-all. A procedure does not need to be named on the list to be excluded; if its purpose is altering sexual characteristics as part of gender dysphoria treatment, Medicaid will not pay.
Why the Exclusion Stands
Two separate legal foundations keep the exclusion in place, and each would have to fall for coverage to resume.
The first is Florida Administrative Code Rule 59G-1.050, which the Agency for Health Care Administration (AHCA) amended in 2022 to add a gender dysphoria subsection.2Florida Agency for Health Care Administration. Adopted Rules – General Policies The rule declares that the excluded treatments do not meet Florida’s definition of medical necessity, which effectively classifies them as experimental or investigational for Medicaid reimbursement.1Legal Information Institute. Florida Administrative Code Ann. R. 59G-1.050 – General Medicaid Policy
The second is Senate Bill 254, signed into law on May 17, 2023, which codified the Medicaid funding prohibition into state statute.3Florida Senate. CS/SB 254 Treatments for Sex Reassignment Because the ban exists in both an administrative rule and a statute, striking down one would leave the other in force.
You may have seen reporting on Dekker v. Weida, in which a federal judge ruled the exclusion unconstitutional in 2023. That ruling is not currently in effect. The Eleventh Circuit Court of Appeals stayed the order in September 2024, and the exclusion is being enforced while the appeal proceeds. The U.S. Supreme Court’s June 2025 decision in United States v. Skrmetti, which upheld Tennessee’s restrictions on gender-affirming care for minors under rational-basis review, has made constitutional challenges to state Medicaid exclusions significantly harder to win.4Supreme Court of the United States. United States v. Skrmetti (2025) For planning purposes, assume the exclusion stays in place.
What Florida Medicaid Still Covers
The exclusion applies to medical and surgical gender transition treatments. It does not apply to mental health care. Florida’s Managed Medical Assistance program covers medically necessary behavioral health services, including psychiatric evaluations, therapy, counseling, and medication management for conditions such as depression and anxiety.5Florida Statewide Medicaid Managed Care. Health Plans and Program These services are available regardless of gender identity, as long as they are prescribed for a covered mental health diagnosis and meet the state’s medical necessity standards.
There is an important limit. A Medicaid recipient diagnosed with gender dysphoria can receive therapy that addresses depression, anxiety, or other mental health symptoms. What they cannot receive through Medicaid is counseling specifically designed as a prerequisite or component of excluded medical transition treatments. The documentation must support a covered diagnosis on its own terms.
How to Appeal a Denial
Any Medicaid denial can be appealed, and the process has two steps. Before starting, know this: when a service is excluded by Rule 59G-1.050 or by state statute, the appeal is unlikely to reverse the outcome, because the denial is based on a categorical exclusion rather than a case-by-case medical judgment. Appeals have a stronger chance when the dispute is about medical necessity for a service that is otherwise covered.
Step One: Internal Appeal with Your Plan
After a denial, your managed care plan will send you a written Notice of Adverse Benefit Determination (NABD) explaining the reason and your appeal rights. You have 60 calendar days from the date on the NABD to file an internal appeal with the plan.6eCFR. 42 CFR 438.402 General Requirements Include medical records, provider letters, and any clinical evidence that supports your request. If the plan upholds the denial, it issues a Notice of Plan Appeal Resolution (NPAR).
Step Two: Fair Hearing with AHCA
Once you receive the NPAR, you can request a state-level fair hearing through AHCA’s Office of Fair Hearings. The request must be received within 120 calendar days of the date the NPAR was sent.7Florida Agency for Health Care Administration. Florida Administrative Code R. 59G-1.100 Medicaid Fair Hearings A hearing officer will consider the evidence, but their authority to overturn a denial based on the categorical gender dysphoria exclusion is limited by the underlying rule and statute. If you are pursuing a fair hearing on an excluded service, consider contacting a legal aid organization with experience in Medicaid and civil rights law before the hearing.