Missouri Supreme Court upholds ban on Medicaid coverage for  gender-affirming care

The Missouri Supreme Court has upheld a law that prevents Medicaid from covering gender-affirming care for transgender people of all ages.

The court ruled unanimously on Tuesday in E.N. v. Kehoe (formerly Noe, et al. v. Parson, et al.) that the state's 2023 law can stand, preventing those on the federal and state insurance programs from accessing the care for the purpose of gender transition, while allowing it for other conditions.

“Today is a disgraceful day as the courts once again failed Missourians," Katy Erker-Lynch, executive director of state LGBTQ+ policy group PROMO, said in a statement. "The Missouri Supreme Court let lies and disinformation dictate what our law should be rather than best healthcare practices recommended by every major medical association in this country."

Related: Missouri Republican Gov. Signs Gender-Affirming Care Ban, Anti-Trans Sports Bill

Senate Bill 49, which Republican Gov. Mike Parson signed into law in June 2023, banned gender-affirming care for youth, while allowing those already receiving treatment to continue. The law also banned Medicaid from covering gender-affirming care — even for adults — and gender-affirming surgeries for incarcerated people. The same treatments are still legal for cisgender patients experiencing conditions such as early-onset puberty or a disorder of sex development.

The U.S. House of Representatives passed a bill in December that would ban gender-affirming care for youth nationally, as well as a separate bill that would prevent Medicaid from covering the life-saving treatment. Both now go to the Senate, where it is unclear if they have the support needed to pass.

Medicaid policy explicitly excludes trans-related health care for all ages in 11 states, according to the Movement Advancement Project: Arizona, Florida, Idaho, Iowa, Kentucky, Missouri, Nebraska, Ohio, South Carolina, Tennessee, and Texas. An additional three states prevent Medicaid from covering the care for minors: Arkansas, Kansas, and Mississippi.

Related: House passes bill banning Medicaid from covering gender-affirming care for youth

The American Medical Association, the American Psychiatric Association, the American Academy of Pediatrics, the American Academy of Child & Adolescent Psychiatry, the World Medical Association, and the World Health Organization all agree that gender-affirming care is evidence-based and medically necessary not just for adults, but minors as well.

"Denying medically necessary healthcare to anyone is not only shameful, but irrefutably wicked. Healthcare for trans young people is lifesaving — end of story," Erker-Lynch said, adding, "To every trans and gender expansive young person, you are not alone. We see you. You matter. And we take care of us. There are people fighting for you every single day."

Families or trans young people who are seeking assistance to access care can find support through the Trans Youth Emergency Project at https://southernequality.org/mo/. PROMO, The GLO Center, PFLAG, and TransParent partnered with The Campaign for Southern Equality to bring resources to those needing care while the current ban continues to be in effect.