The legislation—condemned by civil rights advocates as the Criminalizing Gender-Affirming Care Bill—passed the state Senate in a 26-13 vote and the House by a margin of 83-28. It now heads to the desk of far-right Gov. Ron DeSantis. The presumptive candidate for the GOP's 2024 presidential nomination has previously voiced support for the measure and is expected to sign it into law, upon which it would take immediate effect.
"S.B. 254 is extraordinarily dangerous and extreme in a year full of extreme, discriminatory legislation."
Seven Florida parents who are currently challenging state boards of Medicine and Osteopathic Medicine rules prohibiting gender-affirming care for their children and other trans youth plan to ask a federal court to block provisions in S.B. 254 that would codify the existing boards' bans and create additional barriers for families with trans children.
They are represented by Southern Legal Counsel, GLBTQ Legal Advocates & Defenders (GLAD), the National Center for Lesbian Rights, and the Human Rights Campaign (HRC). The groups issued a joint statement denouncing Florida for "doubl[ing] down on denying science, intruding on family privacy and parental decision-making, and trampling on the rights and well-being of transgender adolescents."
"The bill passed by the Legislature today interferes even further with families, deliberately provoking conflict by inviting challenges to established custody orders. This exacerbates the state of emergency for parents who are already being forced to watch their kids suffer rather than get them the effective healthcare they need and that will allow them to thrive," says the statement. "We will take swift action to ask the federal court to block the ban on access to essential healthcare in S.B. 254, as well as the boards of medicine bans, to stop further harm to transgender youth and their families while the plaintiffs' case continues."
Similar bans on gender-affirming care for trans youth have been blocked by federal judges in Alabama, Arkansas, and Missouri.
Under S.B. 254, the state could take custody of a child who "has been subjected to or is threatened with being subjected to" gender-affirming care such as hormone replacement therapy and puberty blockers.
As The New Republicreported:
Florida courts could modify custody agreements from a different state if the minor is likely to receive gender-affirming care in that second state. The text refers to gender-affirming care as "sex-reassignment prescriptions or procedures" and qualifies this care as a form of "physical harm."
Medical facilities would have to give the state Department of Health a signed attestation that they neither provide gender-affirming care to any patients under the age of 18 nor refer people to providers that do. Their medical license renewal is contingent upon sending in this attestation.
Minors who have already begun transitioning will be allowed to continue to do so, but they are no longer allowed to receive care via telehealth, including for prescriptions. Their doctors have to tell them about the "risks" of gender-affirming care, and patients will have to sign an informed consent form, which the ACLU has pointed out often contains misinformation. Doctors who violate any of these new rules could be charged with a felony.
Equality Florida, the state's largest LGBTQ+ rights group, noted that "while much of the bill proponents' rhetoric focused on transgender youth, multiple bill provisions impact consenting transgender adults."
As the organization explained, "The bill bans government entities from offering them gender-affirming healthcare insurance, restricts their ability to access telehealth for care in the way nearly all other healthcare can be delivered, and denies their ability to receive care from highly trained nurses that provide a large portion of the gender-affirming care in the state." Anyone who violates these provisions could face misdemeanor charges.
As repressive as S.B. 254 is, opponents successfully narrowed the bill from the "much more extreme" House companion filed by state Rep. Randy Fine (R-33), the group pointed out. "Provisions previously approved by the House majority would have banned private health insurance providers from covering care for transgender adults and barred transgender Floridians from updating the gender on their birth certificates. The bill as passed also allows certain transgender youth already receiving gender-affirming treatments to continue doing so, whereas the House provisions would have terminated all care by the end of the year."
Equality Florida public policy director Jon Harris Maurer said that S.B. 254 "painfully shows Gov. DeSantis' 'Florida freedom' farce."
"It's an assault on medical freedom and the freedom to parent," Maurer lamented. "After weaponizing the state's Medicaid agency and Board of Medicine against the transgender community, the governor's surrogates have now rammed through legislation to override parental decision-making, jail Florida doctors following best practices, and force adults to jump through government hoops to access their daily medication. This crusade is about political aspirations, but it has real-world consequences for Florida families."
Maurer's critical assessment was echoed by Cathryn Oakley, HRC's state legislative director and senior counsel.
"S.B. 254 is extraordinarily dangerous and extreme in a year full of extreme, discriminatory legislation," said Oakley. "This bill doesn't even pretend to be responsible public policy—instead, it attacks the ability of people of all ages to access medically necessary healthcare simply because those people are transgender; it prevents parents from being able to access best-practice, potentially lifesaving healthcare supported by the entire American medical establishment on behalf of their children; it prevents healthcare providers from delivering best-practice medical care; and it even threatens to overturn out-of-state custody determinations."
"This bill doesn't even pretend to be responsible public policy—instead, it attacks the ability of people of all ages to access medically necessary healthcare."
Oakley warned that "if Gov. DeSantis signs this bill, he will be disrespecting the United States Constitution as well as the rule of law, not to mention transgender Floridians, their families, and their medical care providers."
"Many families are making plans to leave the state to protect their children and get them the care they need to stay alive," she added. "The Human Rights Campaign is committed to doing everything in our power to fight back against these discriminatory bills and give LGBTQ+ children the futures they deserve."
S.B. 254, The New Republic observed, is "one of the cruelest" anti-trans bills yet passed in the country. "State Republicans have openly admitted they 'hate' LGBTQ people and are comfortable with 'erasing' the community from existence."
Equality Florida urged people to call DeSantis' office at 850-717-9337 to assert that "hate has no place" in the state.
As the organization noted, "S.B. 254's passage comes amidst an unprecedented barrage of anti-LGBTQ, anti-freedom bills in the final week of the 2023 legislative session," all of which DeSantis is expected to sign into law. It elaborated:
On Tuesday, the Legislature passed S.B. 1580, known as the License to Discriminate in Healthcare bill, which creates a broad license for healthcare providers and insurance companies to refuse services based on a "religious, moral, or ethical belief." Despite fears from LGBTQ advocates that this could open the door for discrimination in healthcare services, the bill passed on a party-line vote.
On Wednesday, three bills on the Slate of Hate were sent to the governor. H.B. 1069, the Don't Say LGBTQ Expansion Bill... extends last year's censorship of classroom discussion of sexual orientation and gender identity now up to eighth grade and overrides a parent's right to ensure that school personnel address their transgender child with the correct title and pronouns. The bill also dramatically accelerates book-banning efforts in Florida, allowing any person in a county to automatically remove a book from school shelves pending a lengthy review on the grounds of certain objections. The Legislature then passed H.B. 1521, the Anti-Transgender Bathroom Ban, that imposes new restrictions mandating that bathroom use be separated by sex assigned at birth in schools, universities, public stadiums, regional convention centers, airports, and all government buildings. And finally, H.B. 999, which included language banning public funding for LGBTQ-inclusive diversity and inclusion programs in our state colleges and universities.
Florida's hateful offensive is part of a broader nationwide attack carried out by Republican lawmakers and officials. The GOP claims to be "protecting children," but in reality, it is criminalizing LGBTQ+ people of all ages, putting them at increased risk of violence and self-harm.
HRC said it is opposing more than 520 anti-LGBTQ+ bills introduced in statehouses across the country so far in 2023. According to the group, "More than 220 of those bills would specifically restrict the rights of transgender people, the highest number of bills targeting transgender people in a single year to date."
HRC is currently tracking:
- More than 125 bills that would prevent transgender youth from being able to access age-appropriate, medically necessary, best-practice healthcare; this year, 13 have already become law in Arkansas, Tennessee, Mississippi, South Dakota, Utah, Iowa, Idaho, Indiana, Georgia, Kentucky, West Virginia, North Dakota, and Montana;
- More than 30 bathroom ban bills; and
- More than 100 curriculum censorship bills and 45 anti-drag performance bills.
"In a coordinated push led by national anti-LGBTQ+ groups, which deployed vintage discriminatory tropes, politicians in statehouses across the country introduced 315 discriminatory anti-LGBTQ+ bills in 2022," HRC noted. "Despite this, fewer than 10% of these efforts  succeeded. The majority of the discriminatory bills—149 bills—targeted the transgender and nonbinary community, with the majority targeting children... By the end of the 2022 legislative session, a record 17 bills attacking transgender and nonbinary children passed into law."
"Support for LGBTQ+ rights is on the rise in Florida and nationwide," the group pointed out, citing recent survey data showing that 80% of Florida residents back anti-discrimination protections and 66% oppose refusal of service on religious groups. According to the same poll conducted by the Public Religion Research Institute, roughly 80% of U.S. adults favor laws that would protect LGBTQ+ people against discrimination in jobs, housing, and public accommodations, up from 71% in 2015.