TL;DR
- Missouri’s highest court upheld a Medicaid ban on gender-affirming care.
- The ban applies only to trans people, not cis patients receiving the same treatments.
- The law affects trans people of all ages, including adults.
- Major medical organizations say the care is evidence-based and lifesaving.
- Advocates call the ruling discriminatory and dangerous.
Missouri has made its discrimination official.
On Tuesday, the Missouri Supreme Court unanimously upheld a 2023 law that blocks Medicaid from covering gender-affirming care for transgender people — while allowing identical treatments for cisgender patients with other medical needs.
The case, E.N. v. Kehoe, challenged Senate Bill 49, a Republican-backed law signed by then-Gov. Mike Parson. While the bill is best known for banning gender-affirming care for minors, it also quietly stripped Medicaid coverage for trans adults, creating a carve-out that targets only transgender patients.
In other words: puberty blockers, hormones, and related treatments remain legal — and covered — for cis people. They’re just off-limits if you’re trans.
Advocates condemned the ruling as a clear violation of medical ethics and equal protection.
“Today is a disgraceful day,” said Katy Erker-Lynch of PROMO, Missouri’s leading LGBTQ+ policy group. She accused the court of allowing “lies and disinformation” to override established medical consensus.
That consensus is overwhelming. The American Medical Association, American Academy of Pediatrics, American Psychiatric Association, World Health Organization, and every major U.S. medical body agree that gender-affirming care is evidence-based, medically necessary, and often lifesaving — for both adults and youth.
Missouri is not alone. According to the Movement Advancement Project, Medicaid excludes trans-related health care in at least 11 states, with several more banning coverage for minors. But Missouri’s law goes further by explicitly allowing the same treatments for non-trans patients, exposing the ban as ideological — not medical.
At the federal level, Republicans are pushing similar policies. The U.S. House recently passed bills that would ban gender-affirming care for youth nationwide and strip Medicaid coverage entirely. Their fate in the Senate remains uncertain.
For trans Missourians, the impact is immediate. Medicaid recipients — disproportionately low-income, disabled, and marginalized — are now locked out of care their doctors say they need to survive.
Advocates stressed that support still exists. Groups including PROMO, PFLAG, TransParent, and the Campaign for Southern Equality are helping families navigate care options while the ban remains in effect.
But the message from the court is unmistakable: Missouri is willing to deny lifesaving health care — as long as the people harmed are trans.
And for many, that makes this ruling not just a legal failure, but a moral one.