Missouri this month became the first state in the country to severely restrict sex therapies for people of all ages, following a series of quieter moves across the country that were cutting off transgender adults’ access to medical care.

Last year, Florida joined six other states in banning Medicaid from covering some forms of sex care for transgender people of all ages. This ban affects a file The number of beneficiaries is estimated at 38,000 of the General Insurance Program, according to the Williams Institute, a think tank at UCLA School of Law.

And in at least five states, Republican lawmakers have proposed bills that would eliminate gender sponsorship for minors as well as young adults. Some try to ban it for anyone under the age of 21, and others for those under the age of 26.

The new Missouri sweeping policy took a different approach. Citing consumer protection laws meant to regulate fraud, the state’s attorney general, Andrew Bailey, has issued an emergency rule that prohibits doctors from giving gender-based treatments to patients — of any age — unless they adhere to a slew of important restrictions, including 18 months of psychiatric evaluation. . The rule also stated that patients should not receive gender therapies until any mental health issues had been “resolved”.

said Gillian Branstetter, a communications strategist for the American Civil Liberties Union, whose Missouri chapter is affiliated announce Its intention is to file a legal challenge to the rule.

“The political situation in terms of health care for transgender people has always been here,” said Ms. Branstetter.

The rule excludes people who are currently in treatment, as long as they and their doctors comply “promptly” with psychiatric evaluations and other restrictions.

Arrow Royston, a 35-year-old transgender man in St. Louis, said he was shocked. through the new policy. He said he had been taking testosterone for eight years, monthly Refills prescribed by his doctor. If he could no longer access treatments, he said, he would be devastated, and would travel out of state for care.

“I think what bothers me the most is that I am an active member of this community,” said Mr. Royston, a program manager for a US defense contractor. I have worked on defense programs to protect my nation. And my nation can’t protect me? “

Missouri’s new policy goes into effect April 27 and expires in February 2024, when the state legislature is back in session. (Two bills That would ban underage care — and prevent Medicaid from covering it for all ages — was not advanced in this year’s hearing.)

Although Mr. Bailey’s order applied to all ages, his public comments focused on children, echoing rhetoric from Republican politicians across the country and in Missouri. “As a public prosecutor, I will always fight to protect children because gender transition interventions are experimental,” Mr. Bailey said on Twitter.

In February, his office launched an investigation into the Gender Clinic for Youth at Washington University in St. Louis after a former employee filed a whistleblowing report. complaint Claiming that the patients there were taken to treatment and not enough psychiatric examinations were carried out. (the clinic He said They followed accepted standards of care.)

When asked why it contained adults, Madeline Serene, a spokeswoman for Mr. Bailey, said: “We have serious concerns about how children are treated across the state, but we believe everyone is entitled to access to evidence-based medication and adequate mental health care. “

Another 14 states — Alabama, Arizona, Arkansas, Georgia, Idaho, Indiana, Iowa, Kentucky, Mississippi, South Dakota, Tennessee, Utah, West Virginia and, as of Wednesday, North Dakota — have passed laws restricting gendered care of minors.

Although there is some controversy between Medical professionals About which children will benefit from gender confirmation care and when they should start treatment, there are several large medical groups in the United States, including American Academy of PediatricsThey condemned the legislative ban.

For transgender adults, several studies have shown that transitional care Can Improves myself Well-being and quality of life.

Terry Schilling, president of the American Principles Project, a right-wing advocacy group that has been pushing for restrictions on transgender rights, said in an interview earlier this year that the focus on minors was a short-term political expense. He said his organization’s long-term goal is to eliminate transitional care altogether.

He said, “I see this whole issue as much as I see lobotomy or eugenics – it’s a bad medical fad.”

Mr Schilling said policies could include outright bans on people of all ages, or bills to make it easier for people to sue medical providers if they regret moving. He also raised the possibility of classifying transitional care as “consumer fraud” – the same approach put forward by Mr. Bailey – because it maintains that it is impossible to change sex.

over many years, Seven states – Arizona, Florida, Missouri, Nebraska, South Carolina, Tennessee, and Texas have policies prohibiting Medicaid from covering certain types of gender confirmation care. (The Federal Low-Income Insurance Program is funded in part by states, which also have ample latitude to determine eligibility.)

Christie Mallory, legal director for the Williams Institute, said the Medicaid ban “is based on shaky legal foundations.” Courts in Wisconsin and West Virginia have ruled that such bans violate the Affordable Care Act, which prohibits discrimination on the basis of sex, as well as other federal rules.

But some lawmakers are introducing broader bills that would ban gender-related care in government-owned or operated health centers, or in those that accept government funding.

In Oklahoma, for example, a bill introduced this year by Senator Nathan Dahm would withhold Medicaid reimbursement — for any procedure or treatment — from any health center that provides gender-specific care or works with a provider that provides it.

In an interview in January, Dahm said his sole goal was to prevent taxpayer money from covering the transition. He said, “If an adult wants to make that decision and pay for it themselves, they can do it.” He also acknowledged that this policy could motivate some healthcare providers to stop providing care to adults.

Over the past few decades, doctors Increasingly removed Barriers, such as psychological assessments, for adults to obtain hormonal therapy, shifting decision-making to the patients themselves.

“There is a very broad consensus that gender confirmation care for adults is appropriate and beneficial,” said Erica Anderson, clinical psychologist and past president of the American Transgender Health Professional Association.

Dr. Anderson, a transgender woman, publicly They expressed their concerns About the growing number of adolescents, especially those with complex psychological problems, who seek gender-related care. It also supported the policies of some European countries, incl Sweden And Britainwhich recently restricted when children could undergo certain medical treatments.

But last month, Dr. Anderson joined in Hundreds of doctors In signing a letter affirming that gender affirmation care is beneficial and important to many transgender children, she denounced the legislative ban in the United States. She said efforts to extend these restrictions to adults would add significant harm.

“The lack of clarity between youth and adult care is ominous,” she said. “It is an ominous sign of the transgression of people who believe that the state should decide people’s personal lives.”

Missouri also received opposition among some conservatives in the state. said Secretary of State Jay Ashcroft, a Republican who recently announced he was running for governor St. Louis Public Radio that although he supported bans on children, he did not believe the state should restrict adult care.

“I don’t think people should do that,” Mr. Ashcroft said, referring to adult sex treatments. “But there is a difference between what I think and where I think government should be involved.”

Maggie Astor Contribute to the preparation of reports.