Show Me My Rights Guide: Information for Parents/Families of TGNCI Kids

It’s completely normal to feel surprised or even have mixed emotions understanding and accepting your child or other loved one’s transgender status. This might not be something you’re familiar with or ever envisioned for your child or loved one. Having questions is okay.

The most important thing to understand is that many transgender people live full and happy lives, and gender identity is just one part of who a person is. What your child or loved one needs most right now is reassurance that your love for them hasn’t changed. These two things can be true at the same time: you can be learning and processing what it means for your child or loved one to be transgender or gender non-conforming while still showing up for your child or loved one during this critical time.

Check out our “Resources” list below, which includes organizations specifically for parents/caregivers/other loved ones of transgender, nonbinary, and gender non-conforming (“TGNC”) youth. These organizations offer support groups, guides, and more resources from other parents who started exactly where you are now. You don’t have to figure this out alone!

Yes! Here are a few to get you started:

• The Dads (2026 – feature) & The Dads (2023 – short documentary)
• Will & Harper (2024)
• Disclosure (2020)

“Gender-affirming medical care” includes puberty blockers, hormone replacement therapy (“HRT”), and gender-affirming surgeries.

“Gender-affirming care” refers to more than just medical care. According to the World Health Organization (WHO), it can include “any single or combination of a number of social, psychological, behavioural or medical (including hormonal treatment or surgery) interventions designed to support and affirm an individual’s gender identity.”

See the AAMC’s website for more information about gender-affirming care.

No. Since 2023, Missouri has banned gender-affirming medical care for minors, with very limited exceptions. See RSMo. §191.1720 (formerly known as SB 49, the “SAFE Act”). Under this law, health care providers in Missouri are prohibited from performing gender-affirming surgery and from prescribing or administering hormone therapy and puberty blockers to trans youth who are under age 18.

The law also bars Missouri’s Medicaid program (known as “MO HealthNet”) from reimbursing the cost of gender-affirming care for trans people of any age. Medicaid is a federally funded insurance program designed to improve health care access and outcomes for low-income people. Each state administers its own Medicaid program.

This law also effectively prevents out-of-state doctors from using telehealth to treat minor patients physically located in Missouri. There is no prohibition on a person traveling out of state to obtain medical care.

Yes. Transgender minors can still access mental health care in Missouri. For example, a therapist can use affirming pronouns for a trans child. Current Missouri law does not bar or regulate mental health care for trans youth.

In its original passage of SB 49, the Missouri General Assembly allowed for both an exception for transgender youth currently receiving prescribed puberty blockers and hormone therapy to continue to receive that particular treatment but not transition to a new medical treatment (i.e., the “grandfather clause”) and an expiration date (i.e., the “sunset clause”) for restricting this medical care for minors that would cause the entire law to expire in August 2027. (*Note: the sunset provision applies only to minors’ access to puberty blockers and hormone therapy; the ban on minors receiving gender-affirming surgery in Missouri is permanent.)

During the 2026 Missouri legislative session, a proposed bill (HB 2033) sought to remove these provisions. This bill was defeated. As a result, the law’s provision barring health care providers from prescribing or administering puberty blockers and hormone therapy to trans youth under the age of 18 is still set to expire on August 28, 2027. However, in practice, providers have already ended this care for patients in the state in response to SB 49, and future attacks from the Missouri legislature are expected in 2027.

No. Unfortunately, a local “safe haven ordinance” cannot restore the ability for minors to obtain gender-affirming medical care within Missouri without violating current statewide law. See RSMo. §191.1720.

No. Missouri law does not penalize or criminalize parents or guardians who seek gender-affirming medical care for their minor children, including those parents who travel out of state to seek this necessary medical care.

Instead, SB 49 threatens health care professionals who provide this care in Missouri with the loss of their medical licenses​. See RSMo. §191.1720.

No. Missouri law does not bar health care providers from referring patients to out-of-state providers for the purpose of obtaining gender-affirming medical care where it is still legal to do so.

No. Since 2023, Missouri law bars MO Medicaid (also known as “MO HealthNet”) coverage for gender-affirming medical care for trans people of any age. See RSMo. §191.1720 (formerly known as SB 49, the “SAFE Act”).

First, you might be wondering what Medicaid and Medicare are. See below for a quick intro:

What is Medicaid? Medicaid is a federally funded insurance program designed to improve health care access and outcomes for low-income people. Each state administers its own Medicaid program. Missouri’s Medicaid program is known as “MO HealthNet.” *You can learn more about the eligibility requirements for MO HealthNet coverage here.

What is Medicare? Medicare is the federal government’s national health insurance program primarily for people age 65 or older, as well as younger people with specific disabilities or permanent kidney failure.

Now, let’s turn to the rules:

1) Withholding Medicaid Funding Rule

On August 13, 2026, the Centers for Medicare and Medicaid Services (CMS) published a finalized rule that bans federal Medicaid funding for gender-affirming hormone therapy (“HRT”), puberty blockers, and surgeries for transgender minors. Under this rule, starting October 13, 2026, states will no longer be able to access federal Medicaid funding for gender-affirming medical care, which the Trump administration refers to as “sex-rejecting procedures.”

This rule does not cut off federal funding for psychotherapy related to gender dysphoria, and states may still choose to use their own funds to cover gender-affirming medical care for minors in Medicaid or the Children's Health Insurance Program (CHIP).

This finalized rule is not a federal ban on gender-affirming medical care for minors. No such federal ban exists in the U.S. Many states have actually enacted laws protecting this care (see MAP's website).

This finalized rule will disproportionately harm low-income transgender minors and their families, who rely on Medicaid to access this care. It has already faced a legal challenge. On September 2, 2026, a coalition of 21 blue-state attorneys general and the governor of Pennsylvania filed a federal lawsuit in the District of Massachusetts against the Trump administration, alleging that the new rule oversteps the administration’s authority. The lawsuit is ongoing.

*Note: Missouri law already bars Missouri’s Medicaid program (“MO HealthNet”) from reimbursing the cost of gender-affirming medical care for trans people of any age. See RSMo. §191.1720 (formerly known as SB 49, the “SAFE Act”). 

2) Withholding Medicare Funding Rule

The Trump administration has reportedly shelved a separate rule that would withhold Medicare funding from hospitals that provide gender-affirming medical care to transgender minors.

However, the mere existence of this proposed rule (even though it has not been finalized) has unfortunately led numerous hospitals across the country to cease providing gender-affirming medical care to trans minors.

Yes. We’ve highlighted a few here to get you started. (And you can find more under the “Resources” tab below!)

• The Campaign for Southern Equality’s (CSE) Trans Youth Emergency Project (TYEP) accepts applications from parents or legal guardians of a transgender person under the age of 18 whose access to healthcare has been impacted by a restriction on gender-affirming care. Visit their website for more information and to apply for support.

• Point of Pride is a trans-led nonprofit providing financial aid and direct support to trans folks in need of health and wellness care. Visit their website for more information and to apply for support.

• The Black Trans Travel Fund (BTTF) provides Black trans women with financial and material resources towards education, community, safety and removing travel barriers. Visit their website for more information and to apply for support.

• The Queer Trans Project has partnered with Elevated Access to provide free flight assistance for trans and nonbinary people who need to travel for gender-affirming care domestically (only in the United States). Visit their website for more information and to apply for support.

In June 2025, in United States v. Skrmetti, the U.S. Supreme Court ruled that Tennessee’s law banning gender-affirming medical care for minors does not violate the U.S. Constitution’s Fourteenth Amendment Equal Protection Clause. The Skrmetti decision allows Tennessee’s law, along with laws like Missouri’s ban on gender-affirming medical care for minors, to remain in effect.

Then, in January 2026, in E.N. v. Kehoe (formerly Noe v. Parson), a case that challenged SB 49 in state court under the state constitution and that was already on appeal when Skrmetti was decided, the Missouri Supreme Court cited Skrmetti in unanimously affirming SB 49 and the medical care it banned. The decision in E.N. allows the state to continue denying transgender youth access to medically necessary healthcare in Missouri.

*See our state and federal case updates for more information.

In response to growing attacks on gender-affirming medical care, some states have enacted shield (or “refuge”) laws with the purpose of “shielding” trans minors and health care providers from extradition, civil lawsuits, investigations, and professional discipline for activities related to medical gender-affirming care that are legal in the state where the care is received or provided.

For example, Illinois’ Gender Affirming Healthcare Equity Act bars state agencies from cooperating with out-of-state investigations or arrests related to gender-affirming care because such care is legal in Illinois. See this fact sheet from The Williams Institute at UCLA Law for more information.

You can also visit MAP’s website here for information on which states currently have active “shield” laws in place.

“Conversion therapy” refers to dangerous and discredited therapeutic practices that attempt to change a person’s sexual orientation and/or gender identity through talk therapy. There is no statewide ban on this therapy, but some localities have banned it, and the issue is currently being litigated in Missouri related to a ban in Kansas City and Jackson County. As discussed below, this type of therapy has also been protected by a U.S. Supreme Court Decision.

Kansas City banned conversion therapy for minors in 2019 (see Sec. 50-234 "Conversion therapy of minors prohibited”), and Jackson County enacted its own ban in 2023 (see Ordinance No. 5726, enacting sections 667. and 5575., Jackson County Code, relating to a ban on conversion therapy for minors).

In February 2025, the Alliance Defending Freedom (ADF) filed a federal lawsuit on behalf of Christian licensed counselors in Kansas City challenging the ordinances passed by Kansas City and Jackson County that prohibit conversion therapy for minors. (See Wyatt Bury, LLC v. City of Kansas City.) The Missouri Attorney General intervened in the lawsuit as a co-plaintiff. The counselors brought constitutional claims against the city and county and requested a preliminary injunction (i.e., a temporary court order issued before or during trial to maintain the current situation until the court can make a final decision). In July 2025, the federal district court granted a narrow injunction, blocking Kansas City from compelling counselors to use pronouns inconsistent with their faith under a public accommodations ordinance, but denied the requested injunction and dismissed the counselors’ First Amendment free speech claim against the ordinances. (Read the decision here.) The counselors then appealed the decision to the U.S. Court of Appeals for the 8th Circuit.

While the appeal was pending, the U.S. Supreme Court decided Chiles v. Salazar in March 2026. In Chiles, the nation’s highest court ruled (8-1) that a similar ban in Colorado likely violates the licensed mental health professionals’ free speech rights under the First Amendment and sent the case back to the lower court.

In response, in May 2026, the Kansas City Council voted (7-5) to voluntarily repeal its ordinance banning conversion therapy for minors. The Council majority argued that the repeal was necessary to avoid ongoing and future legal challenges following Chiles. Kansas City leaders are now advancing a revised conversion therapy ban that they state is designed to withstand the Supreme Court’s ruling in Chiles. *For updates, visit the city clerk’s website here.

Meanwhile, in July 2026, the 8th Circuit sent Missouri’s case (Wyatt Bury LLC v. City of Kansas City) back to the U.S. District Court for the Western District of Missouri for further review in light of the Chiles decision. Litigation is ongoing.

*If you are a survivor of conversion therapy, you are not alone. Check out resources like the Conversion Therapy Survivor Network and The Trevor Project for support.

For information on which states currently ban gender-affirming medical care for transgender youth and which remain safe to seek such care, visit the Movement Advancement Project (MAP)’s website here. You can also check out Erin in the Morning for an updated “anti-trans national legal risk assessment map.”

Currently, Illinois is the closest state to any part of Missouri that does not have any current or pending bans on gender-affirming medical care for minors. Other regional “safe” states include Minnesota, Colorado, and New Mexico. (MAP’s website has more information on individual states.)

Yes. You are not alone. We’ve highlighted a few below to get you started:

• The Trans Continental Pipeline (to Colorado)
• Trans Relocation Project (to Washington & Oregon)
• Project Open Arms (to the Pacific Northwest)
• TC Queer Transplants (to Minnesota)
• Trans Resistance Network (to multiple states)
• Move to Thrive Interest-Free Loan Program (to multiple states)
• The Campaign for Southern Equality’s (CSE) Trans Youth Emergency Project (TYEP) (to multiple states)

Unfortunately, this is a deeply personal decision that only you can make, based on many factors such as your risk tolerance, financial circumstances, employment situation, prior travel experience, and other family and relationship considerations here in the U.S.

If you are considering taking this step, here are a few affirming resources to explore:

• Rainbow Relocation Strategies
• Trans World Express
• Trans Rescue
• Asher & Lyric’s LGBTQ+ Travel Safety Index
• Equaldex
• ILGTA – The International Travel Association
• The Williams Institute at UCLA Law’s Global Acceptance Index (GAI)
• You can also subscribe to Erin in the Morning for updates on the legal anti-trans risk assessment in the U.S.

There is currently no federal law that explicitly prohibits discrimination based on gender identity or sexual orientation in public accommodations such as public schools, restaurants, stores, hotels, or theaters.

Missouri state law also does not include statewide protections for transgender people (or LGBTQ+ people generally) in public accommodations.

However, several Missouri cities and towns have local nondiscrimination ordinances that make it illegal for businesses open to the public to deny service or otherwise discriminate based on gender identity or sexual orientation. To find information about specific cities and towns, click here. These local ordinances vary, so your specific protections depend on where the discrimination occurs and which city’s laws apply.

Currently, Missouri does not prohibit transgender people from using restrooms that align with their gender identity. State lawmakers have introduced multiple bathroom bills (including advancing three anti-trans bills in one night during the 2026 legislative session), but thankfully, none have passed yet. Some local school districts also have policies affirmatively allowing transgender students to use the school bathrooms that align with their gender identity.

In 2025, the Missouri Supreme Court heard a case about a transgender student’s right to use public school restrooms and locker rooms consistent with his gender identity. In R.M.A. v. Blue Springs R-IV School District, a transgender boy sued his school district under the public accommodations provision (§ 213.065) of the Missouri Human Rights Act (MHRA), alleging that the school district discriminated against him based on his male sex by denying him access to male-designated restrooms and locker rooms. The central issue in this case was the legal definition of the term “sex” as used by the Missouri General Assembly in § 213.065 of the MHRA. Missouri’s highest court ultimately interpreted the term to limit unlawful sex discrimination in public accommodations to "biological sex," which the court reasoned is determined exclusively by a person's external genitalia. In June 2025, the Missouri Supreme Court issued its decision, holding that public schools may require transgender students to use restrooms and locker rooms based on their sex assigned at birth. However, the R.M.A. decision does not require all Missouri school districts to discriminate against trans students in restroom and locker room use. In other words, Missouri school districts remain free to retain affirming policies allowing for trans students to use school bathrooms and locker rooms that align with their gender identity.

Please be aware that outside of Missouri, your child’s right to use restrooms that correspond to their gender identity may vary by state. In some places, state and local laws that prohibit discrimination based on gender identity or expression should protect transgender people’s right to use public restrooms and locker rooms that match their gender identity. In other states (e.g., see Kansas), lawmakers have banned transgender people from using some facilities consistent with their gender identity. Visit this website for more information on which states have banned trans people from using public bathrooms and facilities according to their gender identity.

Currently, Missouri law prohibits schools from allowing student athletes to compete in athletics that are designated for the "opposite biological sex.” In 2023, Missouri passed the “Save Women’s Sports Act.” RSMo. § 163.048. This law applies to all schools in Missouri: private and public elementary, middle, and high schools; public school districts; and private and public institutions of postsecondary education, including universities, trade schools, and colleges. The law threatens to penalize non-compliant schools by revoking their state funding.

The law includes one exception: a female student may be allowed to compete in an athletics competition designated for male students if no corresponding competition for female students is offered (e.g., football)​. For example, if a school has both a girls’ and a boys’ tennis team, a trans boy is allowed to play only on the girls’ team. Further, according to a recent House amendment, if a trans boy is on hormone therapy, he would be barred from playing tennis on both the girls’ and the boys’ teams.

This law is set to expire in August 2027, but the Missouri House of Representatives has passed a permanent ban on trans athletes in school sports (see H.B. 1663, Sponsor: Seitz)​.

On June 30, 2026, the U.S. Supreme Court ruled that states can ban transgender athletes from playing on women's and girls' sports teams at school. This means that laws like Missouri's “Save Women’s Sports Act” (RSMo. § 163.048) can remain in effect.

See our Students page here.

See our Identity Documents page here.

If affirming your child’s transgender status is a source of conflict between you and your co-parent, it is important to understand your legal rights as a parent or legal guardian. It is also important to recognize that each custody case is unique. For example, your co-parent might unequivocally oppose you taking any steps (e.g., medical or social) that could be interpreted as affirming your child’s transgender status, or your co-parent might specifically disagree with you about the scope of gender-affirming medical care your child should receive.

Here are some basic points Missouri parents should keep in mind when navigating a child custody dispute if that dispute ends up in court or in a divorce proceeding and involves a co-parent who opposes the child’s gender transition:

• In Missouri, a court will always make child custody decisions based on the “best interests of the child” standard. See RSMo. § 452.375.2.
• The court will start by assuming—except in limited circumstances—that awarding equal (or approximately equal) parenting time to each parent is in the best interests of the child.
• To decide what is in “the best interests” of the particular child before it, the court will weigh and apply a series of factors to the specific facts presented in the case. See RSMo. § 452.375.2.
• Unfortunately, we cannot reliably predict how a Missouri court will assess the “best interests” of a transgender or gender non-conforming child when one of the parents in a custody dispute opposes the child’s gender transition because there are no published decisions on this question yet.
• But we do know that the Missouri Supreme Court (our state’s highest court) has so far responded to claims based on gender identity with hostility and skepticism. For example, arguments that seem like they should be persuasive (such as arguing that a co-parent’s refusal to permit the child to travel out-of-state to receive gender-affirming medical care will harm the child’s mental or physical health) are unfortunately unlikely to succeed here in Missouri because of the State’s current stance on trans issues. (Missouri has banned gender-affirming medical care for minors since 2023, and in January 2026, the Missouri Supreme Court unanimously upheld the ban in E.N. v. Kehoe, finding that parents do not have a fundamental right to obtain medical care in Missouri that the legislature has prohibited.)
• In these highly emotional and private cases, you can also consider mediation or alternative dispute resolution (ADR) to avoid going to court.

*A new legal custody handout is coming soon (check back for updates).

Check out PROMO’s Advocacy Insider for information on staying engaged and educated about LGBTQ+ rights across the state of Missouri.

You can also use the Trans Legislation Tracker here.

On February 26, 2026, an extreme anti-trans two-part bill (known as Senate Bill 244) took immediate effect in Kansas. The bill’s first provision prohibits transgender people from updating their driver licenses or state ID cards to reflect their gender, and also invalidates transgender people’s existing driver licenses, state IDs, and birth certificates if those documents were issued in Kansas and reflect a gender different from a person’s sex assigned at birth. The second provision requires transgender people to use the restrooms and other sex-separated facilities in government buildings associated with their sex assigned at birth, while creating new civil and criminal penalties to enforce those restrictions.

*Note: In August 2026, a Kansas judge granted a temporary injunction for a transgender woman whose driver license was invalidated by SB 244. Please be aware that this injunction applies only to this specific person’s license. The ACLU’s lawsuit challenging SB 244 more broadly remains ongoing.

For the most up-to-date information on SB 244, visit the ACLU of Kansas’s website here.

If you or a loved one has been impacted by SB 244 becoming law, contact the ACLU via aclu.org/KS_SB244.

Missouri’s Sunshine Law promotes openness and transparency in government. The law protects access to public records and meetings that are retained by the entity from which the documents are sought. The law states that, “[i]t is the public policy of this state that meetings, records, votes, actions, and deliberations of public governmental bodies be open to the public unless otherwise provided by law. Sections 610.010 to 610.200 shall be liberally construed and their exceptions strictly construed to promote this public policy.” See RSMo. § 610.011. Missouri’s Sunshine Law applies to state, county, and local public governmental bodies within Missouri, including city councils, school boards, and state agencies. The governmental entity does not have to create documentation in response to your request, but they do have to provide you with all open records in their possession that are responsive. They may close or redact certain records as permitted under the law.

If you would like assistance making (or reviewing/supporting) an open records request under the Missouri Sunshine Law, the ACLU of Missouri may be able to help. Please feel free to email us your situation at: showmemyrights@aclu-mo.org.

If your question isn’t addressed above, you may submit it to showmemyrights@aclu-mo.org. Submissions are used to develop general guidance for the public and do not constitute individualized legal advice. This inbox is monitored regularly, but due to volume, we cannot guarantee an individual response to every email received.

This is one section of a multi-part guide. You can find the full guide here:

Trans Justice in MO

he ACLU of Missouri's Show-Me Trans, Gender Non-Conforming, & Intersex Missourians Belong Storytelling Project is amplifying stories of joy and allyship from people like you!

• Add Your Voice: Loved Ones and Allies Form

You are not alone. For additional resources and information for parents, families, and loved ones of transgender, gender non-conforming, nonbinary, and intersex (TGNCI) youth, please see the following local and national resources:

• PFLAG chapters across the state (& for virtual options, visit PFLAG Connects: Communities) & Our Trans Loved Ones publication
• Cooper County LGBTQ+ Alliance Boonville
• The Center Project’s Parents4Parents Group Columbia
• LGBTQ+ Rolla Rolla
• The GLO Center’s Rainbow Families Springfield
• TransParent chapters in St. Louis & virtually
• Campaign for Southern Equality’s Trans Youth Emergency Project (TYEP) National resource
• Translatable National resource
• #TransMascFutures Campaign (organized by InReach x GLAAD) National resource
• Stand With Trans’s Ally Parents & Trans Lifeline Library National resource
• Rainbow in Black National resource
• The National Queer Asian Pacific Islander Alliance (NQAPIA) National resource
• Mama Bears National resource
• Advocates for Transgender Equality (A4TE) National resource
• He She Ze and We (HSZ&W) National resource
• Human Rights Campaign (HRC)’s Parents for Transgender Equality Network National resource
• Desi Rainbow Parents & Allies (DRPA) National resource
• TransFamily Alliance National resource
• Trans Families National resource
• Trans Family Support Services National resource
• LGBT Family Law Service National resource

If you feel your child has been the victim of discrimination based on their gender expression or identity, please consider contacting the ACLU of Missouri for help.