How Medicaid became a battleground between Biden and DeSantis

The DeSantis administration is headed to federal court in Jacksonville to defend its handling of the removal of hundreds of thousands of residents from Medicaid.

The case, originally scheduled for Monday, is among several pending legal challenges that have made Medicaid — a federal health insurance program administered at the state level — an ideological battleground between the DeSantis and Biden administrations. The case was postponed over the weekend by Judge Timothy J. Corrigan. It’s unclear when it will be rescheduled.

The two governments have clashed over Medicaid paying for gender dsyphoria treatments for transgender patients and a provision to keep children insured even when their parents miss premium payments.

Here’s a look at what’s at stake and where the other legal battles stand.

Medicaid terminations

Florida has removed more than 1.8 million residents, including about 600,000 children, from Medicaid since April 2023 when it began the first eligibility check of recipients since the pandemic. But a lawsuit brought by the Florida Health Justice Project and the National Health Law Program in August contends that Florida’s dismissal notices were confusing and did not give adequate due process. Those losing coverage included disabled individuals with complex and expensive medical needs. The federal government is not involved in this case but has publicly criticized Florida for not doing more to keep children insured and expressed concern over call center wait times.

U.S. Middle District of Florida Judge Marcia Morales Howard was scheduled to oversee a bench trial in the Middle District of Florida starting Monday that was postponed. The lawsuit is asking the court to halt terminations and to force the state to temporarily reinstate Medicaid coverage to those affected.

Children’s health insurance

GOP lawmakers in 2023 approved legislation intended to make an additional 42,000 children from low-income families eligible for KidCare, a federally subsidized children’s health insurance program. But the expansion is now in doubt after the DeSantis administration sued the federal government over eligibility rules.

The lawsuit, filed in federal court in Tampa, accuses the U.S. Centers for Medicare and Medicaid of exceeding its authority by telling states they cannot kick kids off the program if their parents stop paying premiums. Such a rule, the lawsuit states, threatens the solvency of the program.

No other state has objected to the rule, which is intended to ensure children have at least 12 months of continuous coverage if parents pay at least the first month. KidCare monthly premiums are either $15 or $20, although most parents pay nothing, according to the KidCare website.

The case is still pending, but health advocacy groups have reported that Florida has removed more than 22,500 children from KidCare since January, which they say is a violation of the new federal rule.

Gender dysphoria treatment

Last year, a federal judge in Florida struck down the state’s rules against using Medicaid to cover gender dysphoria treatments like hormone therapy and puberty blockers.

The judge said Florida’s rules were a violation of equal protection laws and were invalid if they categorically banned those treatments for all gender dysphoria cases.

But the case is far from settled law — and whether the state is following that judge’s order is questionable.

Immediately after the federal judge released his ruling, the state appealed the case to the 11th U.S. Circuit Court of Appeals, where it is ongoing. The 11th Circuit, in a case out of Alabama, held that blocking gender dysphoria treatments for minors is allowed, creating a possible tricky path for LGBTQ+ groups to overcome as they seek to win their legal battle.

And last week, Attorney General Ashley Moody opened a new case in Florida’s Middle District challenging the federal government’s nondiscrimination rule that would require subsidized health programs like Medicaid and the Children’s Health Insurance Program to cover treatments for gender dysphoria.

The state’s lawsuit says that the federal government overstepped, and also argues that denying people coverage for gender dysphoria treatments isn’t discrimination.