After years of escalating attacks at the state and now federal level, restrictions on gender-affirming healthcare for youth are widespread, and their impacts are undeniable. Twenty-seven states have passed outright bans on gender-affirming care for youth, and clinics in states without bans are ending youth gender-affirming care for fear of losing federal funding. State-level bans and clinic closures have forced thousands of families to find new providers and travel long distances to access care.
As gender-affirming care bans and restrictions have been passed across the country, the conservative politicians behind the bans have continually repeated the false narrative that gender-affirming care is not safe for youth, and that this healthcare should be postponed until adulthood. But we know that the far-right groups who are pushing anti-trans policies within state governments and federally want to go beyond banning youth gender-affirming care; they want to ban care for trans adults, too. Kevin Roberts, president of the Heritage Foundation which authored Project 2025, recently said in an interview that he believes gender-affirming care is bad for people of all ages. His solution? “You outlaw it.”
While outlawing care seems to be an ultimate goal for those at the helm of the anti-trans movement, it’s critical to note that gender-affirming care for adults remains legal in all fifty states. However, the environment of fear created by anti-trans policies, executive orders, and federal rules have led to some adult gender-affirming care providers ending care, even when they are not required by law to do so. Additionally, state and federal policies are slowly restricting access to gender-affirming care for adults, beginning with targeting the most vulnerable: those who are incarcerated, those using public funds like Medicare/Medicaid to access care, and those who are employed by the state or federal government.
At the Campaign for Southern Equality, we believe that healthcare is a human right – and we’re working to best understand the current care landscape and get a sense of how widespread these interruptions are across the country. You can help us do that by sharing if you or someone you know has been impacted by an interruption in healthcare access. Click here to share.
Adult Gender-Affirming Care Providers that Have Stopped Care
- Vanderbilt University Medical Center (VUMC) in Nashville, Tennessee announced in February that they will no longer be offering gender-affirming surgeries for adults. VUMC has historically been the largest provider of gender-affirming care in Tennessee and a hub for the surrounding region. There is no federal or state law that required Vanderbilt to end surgical care.
- In November of last year, all Catholic hospitals officially ended gender-affirming care for adults, after an announcement from the U.S. Catholic bishops. While it was not clear how many Catholic Hospitals were offering this care, experts say this change will impact access.
- In South Carolina, a policy banning all public funding from being used “directly or indirectly” for gender-affirming care, resulted in The Medical University of South Carolina (MUSC), the state’s largest provider of gender-affirming care, stopping care for patients of all ages in 2024. While the policy did not explicitly say clinics that receive public funding must end care, MUSC chose to overcomply with the law and end gender-affirming care for all adults.
- Some Federally Qualified Health Centers (FQHCs) have stopped providing gender-affirming hormone therapy for adults despite no law requiring them to do so. FQHCs are federally-funded, community-based clinics that serve primarily low-income patients, and are a provider of hormone therapy for transgender adults. Campaign for Southern Equality has received reports of clinics in Tennessee and North Carolina ending adult care, and news media covered one FQHC in Iowa ending adult care in June of last year. One Nashville clinic, Neighborhood Health, cited the anti-trans political environment at the state and federal levels, a perceived need for increased liability insurance, and a lack of willing providers in their reasons for ending care. It is unclear how many FQHCs nationwide have ended adult gender-affirming care.
- Last month, University of Florida Health (UF Health) reportedly sent a letter to students receiving gender-affirming care through the university notifying them that their care would end in May. As Florida already bans gender-affirming care for youth under 18, it can be assumed that UF Health ended care for students ages 19 and older.
It is evident that the anti-trans political environment is leading to adult gender-affirming care providers ending care, even when no policy explicitly requires them to do so. It is unclear how many providers in the country have ended gender-affirming care for adults.
Policies Restricting Adult Gender-Affirming Care
Restricting gender-affirming care for adults by policy is not just an idea being floated by right-wing policy think tanks; policies being passed in states across the country and at the national level are slowly chipping away at adult access to gender-affirming care by restricting the use of public funds for care.
Laws Restricting the Use of Public Funds for Gender-Affirming Care
- Currently, eleven states explicitly exclude Medicaid from covering gender-affirming care for all ages, with an additional three states banning Medicaid coverage for youth care. This legislative session, many states are moving to expand and solidify their adult gender-affirming care Medicaid bans, including Kentucky, Mississippi, Oklahoma, Tennessee, and West Virginia.
- Some states, including Idaho and South Carolina, go beyond strictly excluding adult gender-affirming care coverage from Medicaid and have passed prohibitions of all public funding use for gender-affirming care. These policies are often drafted so vaguely that they have been interpreted by medical institutions to mean that receiving public funding prohibits them from providing gender-affirming care. These bills have gained traction among conservative lawmakers this year, with bills proposed in Georgia, Oklahoma, Utah, Virginia, West Virginia, and Wyoming.
Bans on State and Federal Employee Insurance Coverage of Gender-Affirming Care
Bans on gender-affirming care coverage by state employee health plans have been in effect in some states for over ten years, and are now being replicated at the national level. Despite numerous successful lawsuits striking down such bans, the policy approach persists.
- Currently, fourteen states explicitly exclude gender-affirming care from being covered by their state employee health insurance programs. This means that individuals employed by those states are not covered under employee health plans for their gender-affirming care, or their dependent child’s gender-affirming care. These bills continue to advance in state legislatures this session, including in Georgia, Kentucky, and Oklahoma.
- This strategy for restricting gender-affirming care coverage is being replicated at the national level by the Trump administration. A notice from the Office of Personnel Management announced in August 2025 that federal employee insurance coverage will not cover gender-affirming care for adults in 2026.
Policies Restricting Gender-Affirming Care Access for Incarcerated People
Policies restricting access to gender-affirming healthcare for incarcerated transgender people have gained traction in recent years. Although there is a long, painful history of transgender inmates being denied adequate gender-affirming healthcare and accommodations as a systemized practice, the passage of formal policies in this area is a relatively recent development. Policies that restrict gender-affirming care access for incarcerated people target a vulnerable population already at high risk of poor health outcomes.
- Currently multiple states, including Idaho, Tennessee, Georgia, Kentucky, North Carolina, and Utah all ban gender-affirming care for incarcerated people. Lawsuits have been filed against these bans in states across the country, with mixed success. In December of last year, a federal judge enjoined a portion of a Georgia law banning gender-affirming care for incarcerated people, and incarcerated people in Georgia can now access gender-affirming hormone therapy.
- President Trump issued an Executive Order in January of last year banning gender-affirming care in federal prisons and immigration detention centers. While the executive order was initially blocked by a federal judge, a new policy released by the Bureau of Prisons last month requires the federal prison system to stop providing gender-affirming medical or social transition care to almost any transgender people.
At this moment, there is a creeping normalization of restrictions on gender-affirming care for transgender people of all ages.
Attacks on gender-affirming care do not end with trans youth, and the most vulnerable are the first to lose access: those who are incarcerated, those who rely on state funds like Medicaid for healthcare access, and those who access care via publicly-funded clinics that accept Medicaid and cater to low-income people, like Federally Qualified Healthcare Centers (FQHCs).
The broader anti-trans political environment is also having a chilling effect, causing clinics to pre-emptively end gender-affirming care for adults, even when no policy requires them to do so.
