Show Me My Rights Guide: Providers of Gender-Affirming Care

Yes. Adults (age 18+) who are not incarcerated can still legally access gender-affirming medical care in Missouri.

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

No. Since 2023, Missouri has banned medical gender-affirming care for minors (and some adults), 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 under age 18.

This law also effectively prevents out-of-state doctors from using telehealth to treat minor patients physically located in Missouri.

SB 49 threatens health care professionals with the loss of their medical licenses for providing such care to minors​. See RSMo. §191.1720.

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.

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.

No. Missouri law does not bar medical or mental health providers from referring patients to out-of-state providers for the purpose of obtaining gender-affirming medical care in a state where such care is still legal.

No. Since 2023, Missouri law bars the state’s Medicaid program (known as “MO HealthNet”) from reimbursing the cost of gender-affirming care for trans people of any age. See RSMo. §191.1720 (formerly known as SB 49, the “SAFE Act”).

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 led hospitals across the country to cease providing gender-affirming medical care to trans minors.

Yes. We’ve highlighted a few below (and see the “Resources” tab for more!):

• 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 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.

If you receive a subpoena requesting your patient’s medical information, you should contact an experienced health law attorney immediately to discuss your specific situation. You can start by contacting your professional/malpractice insurance provider.

*A new handout on this topic is coming soon (check back for updates). 

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

Trans joy is a form of resistance. It reminds us that, despite everything, trans people lead full, complex, and beautiful lives.

The 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!

TGNCI Missourians (ages 18+): Share your story

Loved ones & allies: Show your support

Everyone deserves access to the care they need to live freely. Here are a few organizations that help TGNCI people access gender-affirming care, including financial assistance, travel support, finding an affirming provider, health insurance navigation, and recovery support:

• Campaign for Southern Equality’s Trans Youth Emergency Project (TYEP)
• Flight Assistance - Queer Trans Project x Elevated Access
• Point of Pride
• T4T Caregiving
• Black Trans Travel Fund (BTTF)
• Dem Bois Inc.
• For The Gworls
• Trans Resistance Network
• Nicolas Gogan Foundation (NGF)
• The National Black Trans Advocacy Coalition (BTAC)
• Advocates for Trans Equality (A4TE)’s Trans Health Project
• Plume Clinic
• FOLX Health
• OutList
• InReach

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