TL;DR

• Missouri’s Supreme Court unanimously upheld a law banning Medicaid coverage for gender-affirming care for trans people of all ages.
• The same treatments remain covered for cisgender patients with comparable medical needs.
• LGBTQ advocates call the ruling discriminatory and dangerous to trans health.
• Federal bills could expand these bans nationally, threatening access for millions.
• Trans Missourians are left scrambling for care, relying on mutual aid and emergency support networks.

MISSOURI SUPREME COURT UPHOLDS MEDICAID BAN, DEALS BLOW TO TRANS HEALTH CARE

A ruling that hits trans Missourians where it hurts

Missouri’s Supreme Court delivered a gut punch to the trans community this week, upholding a sweeping ban that bars Medicaid from covering gender-affirming care for trans people of any age. The unanimous decision in E.N. v. Kehoe leaves thousands of low-income trans Missourians stranded without coverage for medically necessary treatments—from hormones to surgeries—while preserving coverage for cisgender patients receiving the exact same treatments for other conditions.

Yes, you read that right: the ban doesn’t target the procedures themselves. It targets who is receiving them.

Advocates didn’t hold back. “Today is a disgraceful day as the courts once again failed Missourians,” said Katy Erker-Lynch of PROMO, the state’s leading LGBTQ+ policy group. “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.”

A law designed to discriminate—by design

Senate Bill 49, signed by Republican Gov. Mike Parson in 2023, was already one of the harshest anti-trans laws in the country. It banned gender-affirming care for trans youth, allowed minors already in treatment to continue, and blocked incarcerated trans adults from accessing affirming surgeries. But its most far-reaching impact came from shutting down Medicaid coverage for gender-affirming care—slamming the door on low-income trans adults and youth alike.

Meanwhile, cisgender patients with conditions like early-onset puberty or disorders of sex development can still get the very same treatments with Medicaid coverage. If you needed a clearer example of discriminatory policymaking, Missouri just produced it in high definition.

The ruling comes as Congress entertains its own set of anti-trans proposals: a national ban on gender-affirming care for youth and a federal prohibition on Medicaid coverage. Whether these measures survive the Senate remains unknown, but Missouri’s decision will almost certainly fuel the talking points of lawmakers eager to impose these restrictions nationwide.

A growing map of exclusion

Missouri is hardly alone. Eleven states—including Florida, Ohio, Kentucky, Tennessee, and Texas—explicitly block Medicaid coverage of trans-related health care. Three others deny coverage for minors. With Missouri’s Supreme Court giving its blessing to the ban, more conservative states may feel emboldened to follow suit.

And yet the medical community remains unequivocal. The American Medical Association, American Psychiatric Association, American Academy of Pediatrics, and even global bodies like the WHO all affirm that gender-affirming care is evidence-based, effective, and—in many cases—lifesaving.

But Missouri lawmakers and judges? They apparently know better.

Trans youth and families left scrambling

For many trans youth and adults in Missouri, Medicaid wasn’t just an insurance option—it was the option. Losing coverage for gender-affirming care means losing access to clinically recommended treatment, uprooting families, or being forced to travel out of state and pay out of pocket.

Erker-Lynch didn’t sugarcoat it: “Denying medically necessary healthcare to anyone is not only shameful, but irrefutably wicked. Healthcare for trans young people is lifesaving — end of story.”

To help bridge the widening gap, organizations like PROMO, The GLO Center, PFLAG, TransParent, and The Campaign for Southern Equality are offering emergency support through the Trans Youth Emergency Project. But no amount of community support can replace what Missouri lawmakers and courts have stripped away.

The LGBTQ Community Deserves Better — and Knows What’s at Stake

For LGBTQ Missourians, this decision is more than a legal setback—it’s a message about whose lives are valued. Gender-affirming care decreases depression, suicide risk, and family rejection. Blocking it endangers lives. Full stop.

The ruling also signals a dangerous escalation in efforts to legislate trans people out of public life. What begins as care bans quickly becomes sports bans, documentation restrictions, and criminalization. We’ve seen this story before, and Missouri’s decision feeds a national movement determined to erase trans existence through policy.

But if Missouri’s trans community has shown anything, it’s resilience. They’ve built networks, supported one another, and fought back case after case. And with advocates and medical professionals loudly defending their rights, the fight is far from over.

For now, though, the Missouri Supreme Court’s ruling is a chilling reminder: discrimination wrapped in legal language is still discrimination. And its impact lands hardest on the people who can least afford it.