Right now, activists in Missouri are forging a pathway towards Medicaid expansion by bringing the decisions to the voters themselves.


Transgender Americans are in a moment of power and of crisis.

At this moment in modern history, Trans people are in the media, and on your newsfeed more than ever before. We hold this power, carrying it from the streets of marches, into the dinner table conversations of the average family. As we reach this crux of power, still, we see our very right to exist freely be debated. In courthouses, and in news stories, statements of our liberation have become a question.  One of the most pressing issues on our plate is the dilemma of the American healthcare system, for Trans individuals, this quandary is especially urgent. 

Sarah Bickham, Street Outreach Worker with Kansas City’s reStart Inc works with houseless trans youth navigating these barriers every day. “A tremendous number of our clients identify as Trans or LGBTQ” Bickham shares, describing the restrictions of Medicaid access in our state. “Individuals classified as men living on their own without children, and without a documented disability simply don’t qualify for Medicaid.” This is a provision in Missouri’s Medicaid program that differs from the majority of states, barring men in mass, while creating further obstacles for the Trans community to navigate.

Trans women, still classified as men in the system face particular urgency to change their gender markers in order to gain access to life-saving care. Bickham recalls the case of a 19-year-old, homeless transwoman. “Tiana has been homeless since she was 16 and has used stimulant drugs on and off during that time to stay awake at night and suppress her appetite in order to survive. She wants to get support to end her substance use and desperately needs mental health support to cope with the trauma she’s gone through. Her mental health needs would count as a qualifying disability but she can’t access the care to get a diagnosis. She’s gone into the ER expressing severe suicidality and been discharged without treatment or any appropriate mental health care.”

In the wake of Kansas City’s fourth murder of a black trans woman this past year, this reality stings.

Trans men, still classified as women with the state can qualify for Medicaid more easily in Missouri, but only while Medicaid files them as women. Charles, one of Bickham’s past clients was a Trans man navigating homelessness, unsupportive family, and access to healthcare all at 17. After working with Bickham to do everything by the book, he was able to begin hormones, change his State ID, Birth Certificate, and live his life as a young man. But even months later, his medical documents through Medicaid were unresolved. This created incredible discrepancy as his prescriptions and medical reports showed a different name than any identification Charles now had. In various shelters, he encountered staff who would “initially refuse to give him his medications” because his information in the two systems were so different. At such a young age, facing these discrepancies within Medicaid echoed a message that the world had no space for trans people, that even state systems built to care for people, inexplicably had no path built for people like him.

The Williams Institute estimates that over 25,000 Trans people call Missouri home. Tens of thousands of us live here, & work here. There is space in this world for people like Tiana & Charles, but it us up to us as a community to end these discrepancies and to forge that space.

Right now, activists in Missouri are forging a pathway towards Medicaid expansion by bringing the decisions to the voters themselves. Aimed for the ballot in November 2020, this measure would end the gender segregation by expanding Medicaid to 215,000  men, families, and children while also lifting some of the weights suffocating the Trans community. If passed, anyone making under $18,000/ year or families of 3 making under $30,000/ year would qualify. Cis, Trans, gay, or straight, this measure would help hundreds of thousands.

As the trans community rallies behind this effort and more, remember that our struggle for liberation is your fight too. Do not forget us when you take to the streets, or to the ballot box on your own. November 2020 will be a moment for all of us, deciding our futures, forging our path. The vote will be up to us, and the future ours.