Missouri Supreme Court Upholds “Sex-Rejecting Procedure” Ban – Clinics Nationwide Halt Services For Youth

The Missouri Supreme Court upheld a state ban on gender affirming care procedures for minors, falling in line with the US Supreme Court’s ruling last year that upheld a similar ban in Tennessee. The legal challenge against Missouri’s law hinged on the claim that the law discriminates based on sex.

Judge Kelly Broniec wrote in her decision that the law classifies based on medical use and age, and thus is not discriminatory in nature. There was also a challenge claiming that a Medicaid ban on treatments violates the state constitution. That claim was thrown out because adults can still access the procedures by paying out of pocket, and Judge Broniec wrote that the state has a legitimate interest in making sure public funds are used efficiently.

The ACLU of Missouri’s Director of Litigation, Gillian Wilcox, denounced the decision. “Today’s decision allows the state to continue to enforce a harmful ban that singles out transgender Missourians and denies them compassion and equal access to medically necessary health care,” Wilcox said. “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.”

According to Kaiser Family Foundation tracking, there are 27 states that have implemented bans or restrictions on gender affirming medical procedures or medications for minors. 17 of those states are facing current, ongoing legal challenges. 24 states also implement professional or legal penalties on practitioners who provide affirming medical treatments to minors.

Health clinics in unrestricted states are also shutting down their youth-based gender affirming care operations as a result of the Trump administration’s crackdown. President Trump promised before taking office that his administration would end the “chemical and surgical mutilation” of children, which started with an executive order signed on January 28.

In May, HHS issued a 400-page report as part of President Trump’s order, which affirms the conclusion of the Cass Report that found there is weak evidence supporting this treatment for minors and significant risks. Weeks later, CMS issued letters to healthcare providers urging them to adjust their treatment protocols based on the findings of the report or risk losing federal funding.

In July, the DOJ issued subpoenas to clinics providing gender affirming treatments to minors. Attorney General Pam Bondi said, “Medical professionals and organizations that mutilated children in the service of a warped ideology will be held accountable by this Department of Justice.” Within weeks, some of the largest youth-based gender affirming care clinics announced they were halting services for youth, including the LA Children’s Hospital.

In December, CMS announced a proposed rule that would prohibit hospitals from providing “sex-rejecting procedures” as a condition of participation in the Medicare and Medicaid programs. The press release notes that nearly all US hospitals participate in the program. The December press release states, “this action is designed to ensure that the U.S. government will not be in business with organizations that intentionally or unintentionally inflict permanent harm on children.”

While the rule faces legal challenges and hasn’t been fully implemented, more clinics have announced a halt to their medical gender affirming programs for youth. Two major hospitals in Madison and Milwaukee Wisconsin, have made the announcement rather than waiting for the federal challenge to play out.

Wisconsin Attorney General Josh Kaul joined the legal challenge alongside the AGs for the states of California, Colorado, Connecticut, Delaware, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, New Jersey, New Mexico, New York, Oregon, Rhode Island, Vermont, the state of Washington, and Washington, D.C.

“Secretary Kennedy must not be permitted to exercise major influence by decree over what health care is available,” Kaul said. “Allowing the HHS secretary to do so could have sweeping consequences for access to quality, evidence-based health care.”

The DOJ is investigating at least three children’s hospitals – Seattle Children’s Hospital, Children’s Hospital Colorado, and Children’s Minnesota – for providing medical “sex-rejecting procedures” to children against federal health care standards.

The DOJ has also moved to subpoena hospitals for additional information about the services they provide to children. U.S. Magistrate Judge Cyrus Chung in Denver threw out a subpoena to Children’s Hospital Colorado, stating, “The Executive Branch cannot engage in new lawmaking on its own and, thus, until and unless Congress creates a statute justifying it, a purpose of investigating the legal activity of gender-affirming care — let alone ending it — cannot ground a legitimate investigation.”

Two weeks ago, Children’s Hospital Colorado announced it was pausing gender affirming services to minors while the DOJ conducts its investigation.

“We recognize the anxiety and grief that this continued uncertainty around access to gender affirming care creates for those who have shown unwavering dedication and commitment to supporting children in embracing their true selves,” the hospital wrote in a note to patients. “We continue to believe that all families, including the families of transgender children, should have the ability to seek and receive the expert medical care their child needs to thrive.”

According to KFF tracking, 50% of trans-identified youth live in states with bans or restrictions. The Williams Institute estimates there are 300,000 youth in the country aged 13-17 who identify as transgender. With clinics shutting down in the states that still are legally able to provide “sex-rejecting” or “gender-affirming” procedures to minors, it is unknown how many of the estimated 300,000 high-school-aged youth are able to continue accessing these services. With federal rule-making underway, access could further diminish, fulfilling the promise President Trump made upon taking office.