Here are the states planning to restrict gender-affirming care next year

Story at a glance

• No fewer than 20 bills targeting transgender medical care have been pre-filed in at least nine states for 2023.

• More than two dozen states in 2022 sought to enact measures to heavily restrict or ban access to gender-affirming health care for transgender youth.

• States with prefiled measures for 2023 include Missouri, Montana, New Hampshire, Oklahoma, South Carolina, Tennessee, Texas, Utah and Virginia.

More than two dozen states in 2022 sought to enact measures to heavily restrict or ban access to gender-affirming health care for transgender youth in one of the worst years on record for anti-LGBTQ legislation.

In the leadup to next year’s legislative session, no fewer than 20 bills targeting transgender medical care have been pre-filed in at least nine states.

Missouri

Three Missouri Senate bills – SB236, SB49 and SB164 – prefiled this month aim to institute an all-out ban on gender-affirming health care for transgender minors, with exceptions for intersex youth. Each measure would establish the “Missouri Save Adolescents from Experimentation (SAFE) Act,” which state GOP lawmakers failed to pass last year.

Identical “SAFE Acts” were introduced in state legislatures across the country in 2022, inspired by legislation passed in Arkansas last year that bans gender-affirming health care for youth and threatens to revoke the medical licenses of physicians that provide such care.

A federal judge last year blocked state officials from enforcing the Arkansas law, which is currently being challenged by an American Civil Liberties Union (ACLU) lawsuit.

A fourth Missouri Senate bill pre-filed this month would similarly prohibit medical providers from performing gender-affirming surgeries or administering puberty blockers or hormone therapy to youth under 18.

Physicians that “willfully and knowingly” violate the measure may be stripped of their medical licenses and parents or guardians that allow their minor child to receive gender-affirming health care will be reported to the state social services department for abuse and neglect.

Montana

Montana House Republicans this month introduced several draft bills targeting gender-affirming health care for transgender youth. One of the proposed measures, backed by Montana Rep. Keith Regier (R), would prohibit transgender minors from undergoing gender-affirming surgeries.

Another four – LC3824,  LC3825, LC3826 and LC3827 – seek to “protect minors from gender transitions” and revise state laws related to gender-affirming health care for youth.

New Hampshire

Legislation pre-filed in New Hampshire aims to prohibit “gender transition procedures” for minors and retool the state’s definition of so-called conversion therapy, a discredited practice that seeks to change a person’s sexual orientation or gender identity.

An earlier version of the bill sought to ban gender-affirming health care for both youth and “young adults.”

Oklahoma

Legislation pre-filed early this month by Oklahoma Republican Rep. Jim Olsen seeks to bar physicians from providing or attempting to provide “gender transition procedures” to patients younger than 21 years old, with an exception for intersex youth.

Under the bill, administering “any medical or surgical service” intended to assist an individual with a gender transition would be made a felony offense, punishable by a $100,000 fine and up to a decade in prison. The bill also bars public funds, including those from the state Medicaid program, from being used to help pay for gender-affirming health care for transgender youth and young adults under 21.

Olsen’s proposed legislation would also restrict the ability of transgender Oklahomans to socially transition or legally change their name or gender marker on official state-issued documents.

South Carolina

A South Carolina Senate bill pre-filed this month would bar transgender people up to 21 years old from receiving gender-affirming health care and require transgender adults older than 21 to obtain a referral from both their primary care physician and a licensed psychiatrist certifying that they have been diagnosed with gender dysphoria in order to receive gender-affirming care.

The bill would also require school teachers and staff to notify a student’s parents or guardians if the student identifies as transgender or struggles with their gender identity.

A second South Carolina bill would bar physicians from providing gender-affirming health care to minors, with an exception for intersex youth, and a third pre-filed measure would amend the state constitution to define “gender” as as a person’s sex assigned at birth, meaning gender markers on state-issued documents like driver’s licenses and birth certificates could not be corrected.

Tennessee

Tennessee House Republicans in November pre-filed a measure to prohibit transgender youth under 18 from accessing gender-affirming health care, stating the legislature has a responsibility to “protect the health and welfare of minors.” An identical bill has been pre-filed in the state Senate.

Texas

At least two bills pre-filed in Texas last month – HB42 and HB112 – seek to designate gender-affirming care for minors as child abuse under state law, effectively codifying a directive from Gov. Greg Abbott (R) earlier this year for state agencies to open abuse investigations into families that allow their minor children to receive gender-affirming medical care.

A third Texas House bill introduced last month would revoke liability insurance for providers that prescribe medications used to treat gender dysphoria in minors.

Utah

Utah state Sen. Michael Kennedy, a Republican, last week pre-filed legislation attempting to ban gender-affirming surgeries – including genital surgeries, top surgery and breast reductions – for minors, with an exception for intersex youth.

Kennedy, a family physician, argued at a state Health and Human Services Committee hearing in October that gender-affirming health care is not medically necessary for transgender people experiencing gender dysphoria – inconsistent with the consensus view of most major accredited medical associations.

Kennedy in 2014 sponsored a measure to bar transgender youth from playing on school sports teams or using restrooms or locker rooms consistent with their gender identity.

Virginia

Legislation pre-filed in November by Virginia Republican Sen. Amanda Chase would establish a “SAFE Act” that prohibits doctors in the state from providing gender-affirming health care to transgender youth younger than 18.

The proposed measure would also bar Virginia’s Department of Medical Assistance Services, which administers the state’s Medicaid program, from reimbursing or providing coverage for gender-affirming services for individuals under 18.

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