Missouri’s ban on trans health care for minors continues, state Supreme Court rules
The Missouri Supreme Court on Tuesday unanimously upheld the state’s ban on gender-affirming care for minors, a landmark ruling allowing state officials to continue prohibiting treatments such as hormone therapy and puberty blockers for people under 18.
The state’s highest court found the ban constitutional, granting state legislators sweeping authority over transgender medical procedures. The ruling rejects a lawsuit on behalf of families of trans youth, medical providers and national LGBTQ advocacy organizations.
The 2023 state law, which lawmakers called the SAFE Act, banned gender transition surgeries on minors — which are rare — and imposed a three-year moratorium on hormone therapy and puberty blockers unless the patients were already receiving the medications.
“Challengers argue the SAFE Act violates parents’ fundamental right to decide the appropriate medical care for their children and children’s fundamental right to healthcare autonomy,” Judge Kelly C. Broniec wrote in the 15-page ruling. “This Court disagrees.”
The ruling is likely to send shockwaves through Kansas City’s transgender community where residents straddle two states that have sought to restrict their rights. Missouri’s ban was part of a nationwide push to regulate the lives of transgender people, stoking fear and prompting some residents to leave the state.
Celeste Michael, a 24-year-old transgender woman from Kansas City, told The Star on Tuesday that the decision caught her off-guard. She said she feared for her community and the potential for future legislation that banned gender-affirming care for adults.
“I’m not in the business of going anywhere unless I’m forced out, because this is my home,” said Michael. “But that doesn’t mean that I would shame or admonish anyone who wants to leave, because, frankly, we are living in very turbulent and unsteady times.”
As Republican lawmakers pursued the ban, most of their attention and talking points centered on a need to stop gender-affirming surgeries, which are relatively uncommon in Missouri.
In addition to the gender-affirming care ban, the ruling also upheld a part of the legislation that affected adults and prohibited Missouri Medicaid dollars from covering gender-affirming care.
Attorney General Catherine Hanaway, a Republican whose office defended the law in court, championed the decision on Tuesday.
“The Attorney General’s Office will continue to stand shoulder to shoulder with parents, lawmakers, and communities to defend Missouri’s laws and preserve the future of our youth,” said Hanaway, who took office in September.
Tuesday’s ruling was bolstered by a U.S. Supreme Court decision last summer that upheld a similar law in Tennessee. Broniec wrote that the Tennessee decision aided the Missouri court’s analysis.
The lawsuit filed by the ACLU of Missouri and the national LGBTQ civil rights law firm Lambda Legal alleged the ban violated several parts of the Missouri Constitution by discriminating against trans patients based on sex and their trans status, among other allegations.
Gillian Wilcox, an attorney at the ACLU of Missouri, said in a statement on Tuesday that the decision allows Missouri to enforce a “harmful ban” that singles out transgender residents. Wilcox signaled that it opened the door for lawmakers to restrict other health care.
“The decision not only allows the state to target transgender Missourians access to health care but also leaves everyone’s health care options at the whims of politicians, should certain care ever fall into the political arena,” Wilcox said.
Meanwhile, PROMO Missouri, the state’s major LGBTQ rights organization, excoriated the ruling in a statement to The Star, saying it was a “disgraceful day.”
“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,” the statement said. “Healthcare for trans young people is lifesaving - end of story.”
Hanaway’s predecessor as attorney general, Andrew Bailey, previously attempted to severely restrict gender-affirming care for both kids and adults by issuing a regulation, a move that raised eyebrows even among some Republicans. He eventually abandoned that effort after lawmakers approved the ban in 2023.
