A federal judge on Wednesday blocked a new health care reform bill from the Biden administration that would conflict with Florida's attempts to restrict treatments such as hormone therapy and puberty blockers for transgender people.

Tampa-based U.S. District Judge William Jung issued a 50-page decision granting a preliminary injunction to prevent the rule from taking effect in Florida.

He wrote that Florida had “demonstrated that it was at imminent risk of harm.” The plaintiffs included the state's Agency for Health Care Administration, which runs the Medicaid program, and the state's Department of Management Services, which administers the health insurance program for state employees.

“The plaintiff agencies and the health care providers they regulate must either clearly violate Florida law or clearly violate the new rule,” Jung wrote.

The rule, which was set to take effect Friday, is designed to help enforce a federal law that prevents discrimination in health programs that receive federal funds. The law prevents discrimination based on “sex,” and the rule would apply that to discrimination based on gender identity as well.

The state filed the lawsuit against the U.S. Department of Health and Human Services and the federal Centers for Medicare & Medicaid Services on May 6, shortly after the rule was finally passed.

Meanwhile, a federal judge in Mississippi also issued a temporary restraining order against the rule on Wednesday in a lawsuit filed by Tennessee, Mississippi, Alabama, Georgia, Indiana, Kansas, Kentucky, Louisiana, Nebraska, Ohio, Oklahoma, South Carolina, South Dakota, Virginia and West Virginia. That injunction applies nationwide, while Jung's ruling was limited to Florida.

The ruling and litigation come after Florida and other Republican-controlled states made controversial decisions in recent years to prevent or restrict treatment for people diagnosed with gender dysphoria, including making health insurance no longer cover treatments such as hormone therapy and puberty blockers and barring treatment for minors.

Florida alleged in its lawsuit that the rule wrongly sought to override treatment restrictions and that it would threaten to lose money to the state and the managed care plans that help run the state's health care programs.

But in a brief filed last month, U.S. Justice Department lawyers argued that the lawsuit was based on “several misunderstandings” about the rule and said the request for a preliminary injunction should be denied.

For example, the summary states that the rule “does not set a standard of care or require the provision of a particular service. Nothing in the rule overrides a physician's medical judgment as to whether a service is medically necessary or appropriate for a patient.”

But Jung wrote, for example, that the rule would force the Department of Management Services to “change its policy regarding reimbursement of gender reassignment treatment costs to members of managed care plans.”

“This is not possible because DMS (the department) cannot change its self-funded insurance plan without the permission of the Florida Legislature, which is currently out of session and has previously prohibited the payment of taxpayer funds for gender reassignment procedures,” Jung wrote. “DMS will clearly suffer irreparable harm if the rule is not stayed.”

Jung also cited rulings from the 11th U.S. Circuit Court of Appeals in gender identity cases, including a 2022 decision that upheld a St. Johns County school board policy that barred a transgender male student from using the boys' restroom at a high school. The Atlanta-based appeals court hears cases from Florida, Georgia and Alabama.

The appeals court said the bathroom policy did not violate Title IX, a federal law that prevents sex discrimination in educational programs. The new health care reform is tied to a Title IX interpretation of sex discrimination, Jung wrote.

“The final rule is stillborn and void if Title IX does not prohibit discrimination based on 'gender identity,'” Jung wrote. “The Eleventh Circuit has been clear on this point: Title IX does not address discrimination based on gender identity. … Frankly, that's the end of the issue — the new rule appears to be a dead letter in the Eleventh Circuit.”

Florida Attorney General Ashley Moody has also joined Alabama, Georgia and South Carolina in challenging a new Biden administration rule on sex discrimination in education programs. The lawsuit alleges, among other things, that the Biden administration exceeded its legal authority by expanding the rules to include discrimination based on sexual orientation and gender identity.

A federal judge in Alabama held a hearing in the education case on Monday but had not made a decision on the states' request for a preliminary injunction as of Wednesday evening, according to an online filing.

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