A one-sentence line in Missouri’s budget just changed prison health care. What to know
AI-generated summary reviewed by our newsroom.
- New provision bars state funds for cross-sex hormones; surgery ban predated it.
- The department allowed prescribed hormone therapy under a policy in place since 2018.
- Critics say the ban could prompt constitutional lawsuits and potential costly defenses.
Missouri will stop providing hormone replacement therapy to transgender people incarcerated in state prisons under a new budget provision signed into law by Gov. Mike Kehoe.
The one-sentence provision, included on the final page of the Department of Corrections appropriations bill, states that “no funds shall be expended for any cross-sex hormones, or gender transition surgery undertaken for the purpose of any gender transition.”
The new restriction builds on an earlier Missouri law enacted in 2023 that prohibited the Department of Corrections from providing gender-transition surgeries to incarcerated people. While that law addressed surgical procedures, the new budget provision also bars state funds from being spent on cross-sex hormones used for gender transition.
Until now, transgender incarcerated people could receive hormone replacement therapy if it was prescribed by a health care professional through the department’s contracted medical provider, said Karen Pojmann, spokesperson for the Missouri Department of Corrections. Gender-transition surgery has never been available in Missouri prisons, she said.
Pojmann said the department’s policy allowing prescribed hormone replacement therapy had been in place since 2018 following a federal lawsuit brought by incarcerated transgender woman Jessica Hicklin.
Pojmann further said that transgender incarcerated people currently had access to prescribed hormone replacement therapy through the department’s contracted medical provider.
When asked how that policy would be affected by the new budget language, Pojmann clarified that her comments referred to the department’s practice before the law took effect.
“Going forward, the health care provider will not be able to use state funds for residents’ hormone replacement therapy,” Pojmann said.
During House debate, House Budget Chairman Rep. Dirk Deaton, a Seneca Republican, dismissed suggestions that the provision conflicted with established court precedent, saying litigation surrounding the issue remained unsettled.
“I was aware there was one case many years ago, and I think there’s ongoing litigation around the country surrounding this, and I think it’s an unsettled area of the law,” Deaton said.
Deaton could not be reached for additional comment.
In a statement after the bill became law, Alliance Defending Freedom Senior Counsel Matt Sharp said the measure protects taxpayers from funding what he described as “harmful” gender-transition drugs and surgeries and praised Kehoe and the bill’s sponsors for approving the provision.
Rep. Wick Thomas, a Kansas City Democrat, criticized lawmakers for including the provision in the budget rather than through standalone legislation and argued the state could ultimately spend more defending the measure in court than it would save.
“There is less than $10,000 spent on gender-affirming care in the state of Missouri, and this is going to cost taxpayers millions of dollars,” Thomas said.
A 2019 Sunshine Law request found about 100 transgender people incarcerated in Missouri prisons, including about 14 receiving cross-gender hormone therapy. Pojmann said the department does not maintain reliable current data on how many incarcerated people identify as transgender or seek gender-affirming treatment.
Federal courts have struck down some state prohibitions on hormone therapy for incarcerated people, while courts have allowed states to prohibit gender-transition surgeries in some circumstances.
Legal questions remain
Legal advocates said Missouri’s decision to discontinue hormone replacement therapy for incarcerated people could expose the state to constitutional challenges similar to those brought elsewhere.
Similar restrictions have typically been challenged under the Eighth Amendment’s prohibition against cruel and unusual punishment because incarcerated people generally cannot seek treatment from another physician if prison officials refuse to provide it, said Megan Noor, a senior staff attorney with the Transgender Law Center.
“People who are incarcerated don’t have the option to go to another doctor and get the health care that they need,” Noor said.
Noor said she was not aware of any immediate plans to challenge Missouri’s provision but said lawsuits over similar laws in other states have generally centered on whether prisons can deny medically necessary treatment.
Wanda Bertram, a spokesperson for the Prison Policy Initiative, said it is difficult to determine how many incarcerated people currently receive gender-affirming care because correctional health systems generally disclose little information about medical treatment.
“It’s hard to say how prevalent this care is,” Bertram said.
Bertram said the uncertainty surrounding the number of transgender incarcerated people receiving treatment reflects broader transparency issues within correctional health care systems, which she said already struggle with chronic understaffing and limited medical resources.
“Prison health care is as bad as it is primarily because states do not put money into it,” Bertram said. “They’re not willing to rise to meet the needs that incarcerated people have in terms of health.”
Similar restrictions have been challenged elsewhere, including in Georgia, where a federal judge ruled that denying hormone therapy to incarcerated people violated the Eighth Amendment. Noor also pointed to ongoing litigation over the Trump administration’s efforts to restrict gender-affirming care in federal prisons.
