Missouri joins growing list of states imposing limits on transgender health care, athletes

Missouri Gov. Mike Parson (R) signed legislation Wednesday that will prevent transgender minors from accessing gender-affirming medical care and bar transgender women and girls from competing on female sports teams.

Both laws will take effect in August.

Missouri's Senate Bill 49, the ban on gender-affirming care, will prohibit health care providers in the state from administering medications including puberty blockers and hormone replacement therapy to treat gender dysphoria in minors, with an exception carved out for transgender youths who began treatment before the law's effective date of Aug. 28.

The measure also bars transgender children and teenagers younger than 18 from receiving gender-affirming surgeries.

"We support everyone's right to his or her own pursuit of happiness; however, we must protect children from making life-altering decisions that they could come to regret in adulthood once they have physically and emotionally matured," Parson said in a statement Wednesday.

"These decisions have permanent consequences for life and should not be made by impressionable children who may be in crisis or influenced by the political persuasions of others," he added.

Missouri joins 19 other states that have enacted laws or policies that heavily restrict or ban gender-affirming health care, 17 of which have done so this year. Gender-affirming care is considered medically necessary by every major medical organization.

Health care providers who violate the new law will have their professional licenses revoked, according to the bill, which also states that administering gender-affirming medical care to a minor "shall be considered grounds for a cause of action against the health care provider" — meaning young patients may more easily sue their doctors.

The new law additionally prohibits MO HealthNet, the state's Medicaid program, from covering transition-related procedures and prevents Missouri prisons, jails and correctional centers from providing gender-affirming medical care to transgender inmates, regardless of their age.

The bill, which passed the Missouri House in May, hit several initial stumbling blocks after its introduction in the state Senate in January, despite a Republican supermajority in the upper chamber. A filibuster effort led by Senate Democrats brought floor action to a screeching halt for several days in March, causing frustrated Republican leadership to adjourn for a scheduled spring break a full day early.

Parson in April threatened to keep lawmakers working beyond the state's regular legislative session, which ended May 30, if they did not pass Senate Bill 49 and Senate Bill 39, the transgender athlete ban.

Both measures were only able to advance through the state Senate after hours of closed-door negotiations between party leaders and an agreement that each law will contain a sunset clause causing each measure to expire after four years. This means both laws would lapse on August 28, 2027.

In an email, state Sen. Mike Moon, a Republican and the sponsor of the gender-affirming health care ban, said he hopes to remove his bill's sunset clause before it expires.

"The reason the clause was added is the democrats wanted it and the republican leadership didn't want to invest the effort necessary to oppose it," he wrote. "In the end, though, I can only blame myself."

Parson's signature on Moon's bill is the latest in a series of steps Missouri officials have taken this year to restrict access to gender-affirming health care for the state's transgender youth and adults.

In April, Missouri Attorney General Andrew Bailey, who is facing reelection, put into effect an emergency regulation claiming gender-affirming medical care for minors is already illegal under a state law that prohibits certain medical interventions in the absence of "substantial guardrails."

Bailey's order, however, included stringent restrictions on care for transgender adults, in addition to children. Among other provisions, the order required that individuals must exhibit at least three years of "a medically documented, long-lasting, persistent and intense pattern of gender dysphoria" to qualify for care.

The emergency rule was abruptly terminated last month.

In February, Sen. Josh Hawley (R-Mo.) announced that his office had launched an investigation into a St. Louis pediatric transgender clinic, after a first-person account from a former employee at the clinic alleged years of malpractice.

Bailey's office has also launched an investigation into the clinic based on the ex-employee's account, which has been challenged by reporting from the St. Louis Dispatch. Nearly two dozen parents of children seen at the clinic told the outlet that the allegations are "just not true."