Gender-Affirming Care in Blue States: From Arizona to Michigan
A review of the literature
by John Morrison
December 17, 2024
Defining “Blue State”
A blue state is traditionally defined as “a US state where most people usually vote Democrat.” For the purpose of this memo, Blue States include states that voted with a majority for Kamala Harris in the 2024 presidential election or states that currently have a Democratic Governor, which amounts to 26 states.
Arizona
Former governor Doug Ducey (R) banned gender-affirming care for minors in 2022. His successor, Governor Katie Hobbs (D), signed two executive orders in 2023 that guarantee gender-affirming surgery for all state employees, implement a shield law, and ban state support of conversion therapy.
On March 30, 2022, Governor Doug Ducey (R) signed two transgender-related bills into law. KFF estimates that Arizona is home to 2.40% of America’s transgender youth (aged 13-17).
Senate Bill 1165 banned transgender athletes from competing in female sports teams at some schools.
Senate Bill 1138 banned gender-affirming care for transgender youth.
Senate Bill 1138 bans physicians from administering any irreversible gender reassignment surgery to anyone under the age of 18. The bill lists four exemptions:
Individuals born with a medically verifiable sex development disorder.
Individuals for whom a physician has diagnosed a sex development disorder and determined through genetic testing that the individual lacks “normal sex chromosome structure, sex steroid hormone production, or sex steroid hormone action.”
Individuals who have suffered infection, injury, disease, or a disorder that’s been caused or exacerbated by a gender transition procedure, whether legal or illegal.
Individuals suffering from illnesses or physical injuries that put them in imminent danger of death unless the procedure is performed.
In June 2023, new Democratic Governor Katie Hobbs signed two executive orders:
The orders guaranteed gender-affirming surgery to state employees. The move reversed a ban from 2017 that was backed by Republicans.
Hobbs banned state support for LGBT conversion therapy.
Hobbs also implemented “shield” style protections that bar state officials from cooperating with civil and criminal cases in states where gender-affirming care is illegal.
The ACLU, along with a University of Arizona professor, filed a class action suit against the state for failing to provide coverage for a hysterectomy. There have been no legal challenges to Senate Bill 1138.
The ACLU and the ACLU of Arizona, along with Professor Russell Toomey of the University of Arizona (a transgender man), filed a class action lawsuit against the state when Toomey was denied coverage for a hysterectomy.
The five-year class action settlement cost the state over $1 million and ruled in favor of Toomey.
Governor Doug Ducey (R), who signed SB 1138 and 1165, has since been succeeded by Governor Katie Hobbs (D), and she has vowed to veto all anti-LGBTQ bills.
Hobbs broke an Arizona record for most vetoes after just 15 months in office, including a veto of SB 1001, which would have banned educators from referring to students under the age of 18 by their preferred pronouns without written consent from their parents.
Hobbs also vetoed Senate Bill 1182, which would’ve banned students from using multioccupancy showers at school events that did not align with their biological sex.
The bill would’ve also forced schools to provide private shower rooms for students unwilling to obey the new law.
Hobbs vetoed Senate Bill 1628, which would have replaced all mentions of gender in state law with a strict definition of biological sex.
The bill would’ve also separated individuals in locker rooms, bathrooms, sports teams, and domestic violence and sexual assault shelters by biological sex.
Governor Katie Hobbs (D) has vowed to block any anti-LGBTQ legislation, while Republicans accused Democrats of launching a war on women and girls by pushing gender-affirming care to appease a small minority
Speaking about her decision to veto Senate Bill 1182, Governor Katie Hobbs said,
“As I have said time and again, I will not sign legislation that attacks Arizonans.”
Senate Republicans said Democrats in the state who were opposed to the bill were launching a,
“War against women and girls.”
Senator John Kavanagh, the sponsor of Senate Bill 1182, said,
“Girls should not be forced to shower with boys in our taxpayer-funded public schools. It’s utterly disgusting that Democrats, who are out-of-touch with reality, continue to push gender neutrality upon our children, endangering their safety and well-being just to politically platform off a small population they pretend to care about.”
Polling by Arizona State University, conducted in 2023 (along with other universities in the country) found a large majority of Arizonans opposed gender-affirming care for minors. However, polling by State Innovation Exchange found a slight minority of Arizonans support such legislation.
In 2023, Arizona State University, the University of Houston Hobby School of Public Affairs, Stanford University’s Bill Lane Center for the American West, and the Stanford Institute for Economic Policy Research (SIEPR) conducted a joint survey on attitudes towards transgender policies in their respective states. A majority of residents in all three states opposed the legislation, and the results for Arizona are as follows:
Some 51% of Arizonans oppose transgender people receiving gender-affirming medical treatment while under the age of 18, while 30% support and 19% are unsure.
Some 54% of Arizonans oppose transgender people choosing which bathroom to use, while 27% support and 19% are unsure.
Some 63% of Arizonans oppose transgender people participating in women’s sports, while 20% support and 17% are unsure.
State Innovation Exchange polling found that Arizonans support parents being allowed to access gender-affirming medical care on behalf of their children by a margin of 51 to 45%.
The polling was released in February 2023 and conducted between 17-20 December 2020.
California
Senate Bill 107, a “first-in-the-nation bill,” saw California become a “sanctuary” state for transgender youth seeking gender-affirming care, while SB 923 protects the right of Californians to access Gender-Affirming health care services. But Gavin Newsom vetoed Assembly Bill 2442, which would have expedited the medical licensure of out-of-state healthcare providers who administer gender-affirming care.
In 2022, Governor Gavin Newsom signed Senate Bill 107, a “first-in-the-nation bill” that saw the state named a “sanctuary” for transgender youth wanting gender-affirming care. The law provides safeguards for transgender youth and their families, especially those arriving from outside of California, against gender-affirming care bans.
The law bans enforcement agencies from removing a child, based on the order of another state’s law, from their parent or guardian, because they received gender-affirming care.
The law bans healthcare providers, contractors, and service plans from sharing medical information with other states in response to criminal or civil action.
The law bans enforcement agencies from “knowingly making or participating in the arrest or extradition of an individual pursuant to an out-of-state arrest warrant based on another state’s law” regarding a minor receiving gender-affirming care in California.
One of the more controversial parts of the law is the section that allows California courts to take temporary emergency jurisdiction when a child hasn’t received gender-affirming care in another state. Reuters reports that:
“When minors are in the state for gender-affirming care they cannot receive elsewhere, the bill says that the situation falls into an existing category of “emergencies” that give California courts clear jurisdiction: “A court of this state has temporary emergency jurisdiction over a child if the child is present in the state because the child has been unable to obtain gender-affirming health care or gender-affirming mental health care.”
“While SB 107 (here), does not grant California courts any new powers to take custody of minors away from parents, according to legal analysts, it was designed in part to prevent California courts from participating in another state’s attempt to take custody away from parents for providing gender-affirming care to their child.”
From 1 January 2023, California implemented SB 923, or the Transgender, Gender Diverse, and Intersex (TGI) Inclusive Care Act.
According to the Department of Managed Healthcare, the Act “protects the right of Californians to access Gender-Affirming health care services.”
Health plans are required to provide transgender enrollees with gender-affirming care, including medical and surgical interventions.
OutCare also reports that “By February 14, 2025, all healthcare service plan staff in direct contact with enrollees must complete cultural competency training focused on providing trans-inclusive care.”
However, in September 2024, Gavin Newsom vetoed Assembly Bill 2442, which would have expedited the medical licensure of out-of-state healthcare providers who administer gender-affirming care.
A Sacramento judge dismissed a case to have SB 107 declared as unconstitutional, even though critics say it gives California the power to “reach into families’ homes in all 50 states”. The famous Jeff Younger-Anne Georgulas custody battle also ended up in California.
Our Watch with Tim Thompson, a nonprofit organization associated with a conservative church in Temecula, where Thompson is pastor, filed a lawsuit to have SB 107 declared unconstitutional. The plaintiffs were represented by lawyers associated with Advocates for Faith and Freedom.
The initial filing was on 7 March 2023, but on their third attempt to strike down the law in 2024, Judge Dale A. Drozd of Sacramento dismissed the case and banned the plaintiffs from making further filings because they would be "futile under the circumstances.”
Family Freedom Project says SB 107 means California can “reach into families’ homes in all 50 states”:
“Under this law, a child from another state who runs away to California or is transported there with the help of another will be able to obtain gender reassignment care and even reassignment surgery without the consent or knowledge of the child’s parents back home.”
“Even more insidiously, the bill empowers California judges to remove custody from the child’s parents.”
“In divorce cases, a parent about to lose custody of their child could abscond to California, give their child cross-sex hormones, and win custody of the child under California law.”
“A minor who runs away from home in Texas and gets a ride to California could go through transition surgery without parental knowledge or consent, and the parents could lose custody of the child completely. Any non-parent could easily use the law to transport a child to California, have them surgically transitioned without parental knowledge or consent, and then win custody of the child.”
“Even if a child never visited California, they could obtain puberty blockers via telemedicine from a doctor in California, and the parents would be denied medical information about their child.”
The Jeff Younger-Anne Georgulas custody battle saw the two Texas parents fight over custody of their twin children. One of the children was a five-year-old transgender girl diagnosed with gender dysphoria. Younger denies that the child is transgender, while Georgulas affirms it.
In 2019, a Dallas court granted shared custody, but in 2021, it granted Georgulas sole custody. However, both parents were obliged to consent for their child to receive gender-affirming treatment.
Younger went to the Supreme Court of Texas to stop Georgulas from taking the children to California after it had passed SB 107, but the court dismissed his petition.
In November 2024, a Los Angeles Superior Court judge granted Georgulas full custody and complete medical authority over their child.
Gavin Newsom and Attorney General Rob Bonta have both positioned themselves as bulwarks against laws targeting transgender youth.
When Gavin Newsom signed SB 107, he said that the law is a sign California stands “for parental choice”, unlike states that he says attack the rights of parents of transgender children. He also claimed attacks on transgender people lead to suicides.
“Parents know what’s best for their kids, and they should be able to make decisions around the health of their children without fear. We must take a stand for parental choice.”
California Attorney General Rob Bonta praised the court’s decision to dismiss the Our Watch with Tim Thompson case.
“No one should ever be marginalized for seeking the care they need… My office stands ready to defend SB 107 to ensure transgender and gender-nonconforming individuals obtain the care that empowers them to lead healthier, happier lives.”
Two separate surveys found that Californians oppose gender-affirming care for minors. This is surprising, as a Gallup poll from June 2024 claims that some 61-62% of Americans oppose laws that ban certain types of gender-affirming care for minors.
In 2023, the Stanford Institute for Economic Policy Research (SIEPR) and Stanford University’s Bill Lane Center for the American West conducted a joint survey with Arizona State University and the University of Houston Hobby School of Public Affairs on attitudes towards transgender policies in their respective states. A majority of residents in all three states opposed the legislation, and the results for California are as follows:
Some 41% of Californians oppose transgender people receiving gender-affirming medical treatment while under the age of 18, while 35% support and 24% are unsure.
Some 45% of Californians oppose transgender people choosing which bathroom to use, while 35% support and 20% are unsure.
Some 53% of Arizonans oppose transgender people participating in women’s sports, while 26% support and 21% are unsure.
Spry Strategies conducted a November 2023 survey of likely California voters that matched the state’s political and racial makeup. It found that 63.5% of respondents opposed gender-affirming care for minors, while 20.7% supported such care.
A Gallup poll found that almost two-thirds of Americans oppose laws that ban gender-affirming care for minors.
Colorado
Colorado is considered a transgender sanctuary state and is the first state to include gender-affirming care as an essential health benefit. The state then signed SB23 - 188 into law, which bans the state from engaging in criminal or civil lawsuits against anyone involved in providing or receiving gender-affirming care, as well as abortions.
On 1 January 2023, “Colorado became the first state to include gender-affirming care services as an essential health benefit” (EHB). The state made its initial announcement in October 2021.
Then, in April 2023, Governor Jared Polis (D) signed three abortion and/or transgender-related bills into law. The bill relating to gender-affirming care is SB23: 188:
The bill bans the state from engaging in criminal or civil lawsuits against anyone who receives, provides, or assists with gender-affirming care, as well as abortions.
The bill made Colorado the first state to protect so-called transgender treatment “tourism.”
In March 2024, the Colorado Senate Education Committee passed House Bill 24-1039 by four votes to three.
The bill would mandate Colorado school boards and pilot schools to use a student’s chosen name.
Denver ABC reports that “the bill defines a chosen name as any name a student requests to be called that is different from their legal name but reflects their gender identity.”
The Colorado Supreme Court unanimously rejected Initiative 175, which was a proposed ballot initiative that would’ve banned gender-affirming care for minors. In two separate cases, Colorado parents are suing over a school’s policy to allow transgender students to room with cisgender students, and a case where a school encouraged a 14-year-old girl to transition without her parents’ knowledge.
In June 2024, the Colorado Supreme Court unanimously rejected a proposed ballot initiative for November that would‘ve banned gender-affirming care for minors. The exemptions would’ve permitted gender-affirming care for minors only for reasons other than gender affirmation, like a birth defect or premature puberty.
The proposal was called Initiative 175 or “Prohibit Certain Medical Procedures for Minors”.
The Denver Post says the court rejected the proposed measure because “supporters of Initiative 175 had not quickly enough appealed a state administrative board’s rejection of the proposal.”
In September 2024, outlets reported that Joe and Serena Wiles, parents to a fifth-grade girl in a Colorado elementary school, are suing their school district “over a policy that transgender students should room with cisgender classmates on overnight trips.”
The ADF is representing the parents in Wailes v. Jefferson County Public Schools.
Outlets reported in October 2024 that a Colorado couple is suing the State of Colorado, the Education Department, and the 27J School District for violating their constitutional rights by encouraging their daughter to transition to a different gender without their consent or knowledge. CBS reports that the issue revolves around Colorado’s Name Change Law,
“A new state law that requires schools to use the preferred name and pronoun of students who are transitioning to a different gender, and a policy at 27J Schools that prevents high schools from notifying parents without a student's consent, noting, in some cases, telling parents puts kids at risk.”
A school counselor at Brighton High School secretly connected the 14-year-old with a transgender therapist who recommended hormone treatment and breast removal surgery.
Like California, Democrat politicians in Colorado position themselves as bulwarks against anti-trans legislation in red states. Republicans in the state fight back against legislation that they say will attract vulnerable children to the state from across America.
Colorado has positioned itself as a transgender safe haven amid a sea of red states, and State Sen. Julie Gonzales said at the signing of the trio of bills:
“What do we do when trans rights are attacked? Stand up and fight back.”
On the signing of a trio of bills to protect abortion and transgender care rights, including SB 23 - 188, Governor Polis made a banal statement about protecting freedoms.
“Here in Colorado, we value individual freedoms, and we stand up to protect them…I’m excited by the work of advocates and legislators to further Colorado’s reputation as a beacon of freedom, a beacon of choice, a beacon of individuality where we live our own lives on our own terms in a Colorado for all.”
Rep. Meg Froelich, a Greenwood Village Democrat, said of the heated debates around the bills,
“The new patchwork of laws across the U.S. is confusing and dangerous. Our fundamental rights have been reaffirmed, established and tested in Colorado.”
“It was a lot — three bills and many days of debate. But the threats are real, and there is an urgency now due to the landscape.”
Colorado House Minority Leader Mike Lynch (R) said the trio of bills would attract “the vulnerable, the indigent and frightened minors from all over the country”.
There’s next to no useful polling on attitudes towards gender-affirming care in the state, but politicians and media coverage have you believe that the state is a safe haven for trans people.
The most relevant survey is a 2019 survey of Coloradans, which found that 77% of respondents support LGBT anti-discrimination laws in the state, versus 18% who oppose and 5% who have no opinion.
Connecticut
Connecticut is considered a transgender sanctuary state and has numerous laws and bills in place to protect the administration of gender-affirming care.
Connecticut is a transgender sanctuary state, along with California, Colorado, Illinois, Maryland, Massachusetts, Minnesota, New Jersey, New Mexico, Vermont, and Washington.
A 2020 ruling by the Connecticut Commission on Human Rights and Opportunities ruled that employers and insurers are banned from denying healthcare coverage related to gender transition to transgender people.
In 2022, Connecticut passed the Reproductive Freedom Defense Act, the first shield law in America that protects patients and medical providers from legal consequences for providing legal gender-affirming care and abortions.
Public Act 23-128 protects medical providers administering gender-affirming care or reproductive services against “baseless” attacks on their licenses, credentials, privileges, and malpractice insurance.
Connecticut has in place several guardrails against out-of-state investigations:
HB 5414 (Conn. 2022) (Conn. Gen. Stat. § 54-155b) states that public agencies and officials cannot engage in criminal or civil proceedings against individuals who provide or seek gender-affirming care that is legal in Connecticut. This includes sharing information or providing money, time, or resources to help such cases.
HB 5414 (Conn. 2022) (Conn. Gen. Stat. § 54-162) states that the Governor of Connecticut cannot extradite individuals charged in another state if the alleged acts are not punishable under state law, so long as their consequences took effect in Connecticut.
HB 5414 (Conn. 2022) (Conn. Gen. Stat. § 54-82i(b)) states that courts cannot issue a summons for the criminal violation of another state’s laws related to the administration and receipt of gender-affirming care (and abortion) that is legal in Connecticut.
Courts are also banned from issuing subpoenas related to gender-affirming care (and abortions) that are legal in Connecticut.
Connecticut has in place several guardrails to protect healthcare professionals from professional discipline for administering gender-affirming care:
HB 6820 (Conn. 2023) (Conn. Gen. Stat. §§ 19a-17e, 20-579a, 52-571m (defining “reproductive health care services”) states that the Department of Health, Commissioner of Consumer Protection, and Commission of Pharmacy cannot deny a license or take disciplinary action based on another state’s disciplinary action related to gender-affirming care and abortions, so long as the act is legal in Connecticut.
HB 6820 (Conn. 2023) (Conn. Gen. Stat. § 19a-567) states that an institution cannot punish or refuse to issue or renew credentials against a health care provider for administering or helping with gender-affirming care and abortion services that are legal in Connecticut and “were provided before the provider entered into an employment relationship with the institution, or were provided outside the scope of the employment relationship.”
Connecticut has in place several guardrails to protect individuals from civil and professional liability:
HB 5414 (Conn. 2022) (Conn. Gen. Stat. § 52-571n) states that any individual or entity that has had a judgment made against them in another state can bring action to recover damages from the plaintiff or party that enforced it, so long as the action was based on the administration or receipt of gender-affirming care or abortion services that are legal in Connecticut.
HB 6820 (Conn. 2023) (Conn. Gen. Stat. §§ 38a-835, 52-571m (defining “reproductive health care services”)) rules that insurers are banned from taking adverse action based on the administration or receipt of gender-affirming care or abortions that are legal in Connecticut. This includes out-of-state cases.
Connecticut has in place several guardrails to protect medical information and data related to gender-affirming care and abortions:
HB 5414 (Conn. 2022) (Conn. Gen. Stat. §§ 52-146w, 52-146x) states that healthcare providers, plans, and clearinghouses cannot disclose any information from a patient’s physical exam related to gender-affirming care or abortions that are legal in Connecticut.
SB 3 (Conn. 2023) (Conn. Gen. Stat. § 42-526) states that no business in Connecticut can sell consumer health data without consumer consent.
House Bill 5424, “An Act Prohibiting Adverse Actions Against Health Care Providers for Providing Certain Health Care Services”, will expand on the 2022 Reproductive Freedom Defense Act. It will protect providers from providing care and information to their patients.
A Connecticut federal judge ruled that the Department of Corrections must provide gender-affirming care to transgender prisoners. Meanwhile, a group of female student athletes is suing the state’s schools for allowing transgender athletes to compete in sports according to their gender identity.
In August 2024, a Connecticut federal judge ruled that the Department of Corrections must provide gender-affirming care to transgender prisoners.
Veronica May-Clark, a 48-year-old transgender woman, is serving a 75-year sentence for bludgeoning to death Clark’s former wife’s boyfriend. Clark sued on the basis that the DOC was violating the Eighth Amendment (freedom from cruel and unusual punishment) and the Fourteenth Amendment (right to equal treatment under the law).
A U.S. District judge had ruled in favor of Clark in 2023, but the Connecticut Attorney General appealed the decision.
The case was the first in the Second Circuit (Connecticut, New York, and Vermont), and the ACLU legal team has stated its hope that the case will mean prisoners no longer need to take legal action to get gender-affirming care.
In November 2024, a federal judge refused to dismiss a case that challenges Connecticut’s policy to permit transgender students to compete in sports according to their gender identity.
The plaintiffs in Soule et al v. CT Association of Schools et al are four biological female track athletes who argue that the policy has deprived them of wins and athletic opportunities because they have been made to compete against two transgender sprinters.
US District Judge Robert N. Chatigny had initially dismissed the lawsuit in 2021 but changed his stance and refused to dismiss the case a second time. He said there’s “little guidance” on how courts should deal with the issue of transgender athletes.
Connecticut Democrats are at pains to brandish their LGBTQ+ credentials.
Lamont called on the LGBTQ community to “Come to Connecticut, we welcome you… we can be a guiding light to make sure that everybody knows they belong”.
Ahead of Pride 2023, Governor Ned Lamont said:
“At a time when it seems that LGBTQ+ rights are under attack across the nation, it is my hope that Connecticut stands out as a welcoming state.”
“Connecticut is emerging as (a) destination for LGBTQ+ tourism. (We recently became the first state to join the LGBTQ+ Travel Association.”
State Representative Matt Blumenthal spoke in 2023 about Connecticut’s sanctuary credentials when speaking about the various reproductive and gender-affirming bills the state has passed:
“This year, as extreme abortion bans and other attacks on women's and LGBTQ healthcare have proliferated elsewhere in the country, we haven't let up. We continued our national leadership in the fight to protect our healthcare providers, residents, and those who come here for care from other states' barbaric laws, and to ensure that every person has access to the healthcare they need and deserve.”
There’s no useful polling on attitudes towards gender-affirming care specifically, but citizens of Connecticut overwhelmingly support LGBTQ+ issues.
A 2022 poll revealed that some 81% of residents support same-sex marriage, with just 18% opposing and 1% unsure.
Meanwhile, a 2019 poll found that 77% of residents support LGBTQ anti-discrimination laws in the state, with just 17% opposing and 6% unsure.
Delaware
Delaware is generally not considered a transgender sanctuary state. It bans insurance companies from limiting coverage for transgender enrollees, and while Delaware does not have laws prohibiting transgender rights, neither does the state enshrine those rights in law.
Delaware, along with New Hampshire and Pennsylvania, is the only blue/purple state in the northeast that is not deemed to be a transgender sanctuary for gender-affirming care.
HB 455, Delaware's shield laws, apply to reproductive care and do not apply to gender-affirming care.
In 2016, Delaware became the 15th state to prohibit insurance companies from limiting health care coverage for transgender enrollees.
In 2023, the Delaware General Assembly introduced HB 230, which provides legal protections for medical professionals who administer gender-affirming care and bans healthcare providers from sharing patient records without consent.
But state Rep. DeShanna Neal (D), who sponsored the bill in 2023, would strike down the bill in March 2024 without directly explaining why. However, her legislative aide told reporters that HB 230 was already out of date, and Neal is working on a new bill to introduce.
Delaware Live notes that this can happen in the state because “Delaware’s legislative session runs over two years, and this one is 2023-2024.” If Neal were to introduce the bill before the end of 2024, then it would have to be reintroduced in the next session starting in January 2025.
In June 2024, Delaware Republicans introduced Senate Bill 315, which would have banned gender transition surgery for minors, but the bill did not progress any further.
Governor John Carney (D) signed HB 346 in 2022, which provided legal protection to healthcare professionals administering abortion and contraceptive services.
In March 2024, the House Health and Human Development Committee passed Rep. DeShanna Neal’s (D) bill to extend protections to providers of gender-affirming care. The bill would’ve seen Delaware become a sanctuary state for procedures, but it did not progress before the end of Delaware’s legislative session.
There are no notable lawsuits to speak of, but Nancy Mace’s bathroom bill in Congress was initiated in response to the election of Delaware Representative Sarah McBride.
Not a state issue, but Rep. Nancy Mace’s trans bathroom bill was initiated in response to the election of Delaware Representative Sarah McBride.
Democrats cite transgender laws in red states when pushing their own bills through. Republicans in Delaware are much more vocal in their opposition to gender-affirming care policies compared to other blue states.
State Rep. Deshanna Neal (D) sponsored HB 230 with five additional sponsors and cosponsors, all of whom are Democrats. Neal said she sponsored the bill in response to other states that restrict gender-affirming care,
“We are seeing other states weaponizing their laws against the transgender community, and we should be clear that we will not let those other states’ laws prevent people from seeking gender-affirming care in Delaware.”
Senate Republican Leader Gerald Hocker and Senate Republican Whip Brian Pettyjohn issued a statement in opposition to HB 230 in which they said,
“Children are rarely held criminally liable because they are still developing mentally, emotionally and cognitively. They do not have the same level of judgment or grasp of their consequences as adults.”
“So, why would we permit a child to undergo irreversible changes to his or her body when their minds and bodies have yet to mature?
“This is possibly the most blatant erosion of parental rights in the history of our state. We will not stand for this type of legislation becoming law and neither should Delawareans.”
Republican Senator Bryant Richardson said he opposes HB 230 and gender-affirming care for minors in general, but not for adults, so long as insurance doesn’t cover procedures.
“I don’t think taxpayers should pay for it,” Richardson said. “And I don’t think insurance companies should pay for it because ultimately it’s other insurers that are footing that cost…I think it’s very dangerous for adults to do it. But…it’s legal for adults to do it. So you really can’t control what another adult is doing, but I think you really need to protect children.”
There’s no significant polling on attitudes towards transgender issues.
Hawaii
Hawaii is generally not considered a sanctuary state for transgender care, and its Shield Law only applies to reproductive care. Governor Ige most notably signed HB 2405 in 2022, which banned health insurers from limiting gender-affirming care that is medically necessary. The House passed HB 2079, which, if signed, will “expand telehealth access to people seeking gender-affirming health services.”
Hawaii is not a sanctuary state for transgender care. Hawaii does have a Shield Law to protect reproductive care, but this does not extend to gender-affirming care. Hawaii does not have specific laws enshrining or prohibiting:
Transgender people using a bathroom or facility consistent with their gender identity in government buildings.
Explicitly defining state sex in state law to exclude law.
Banning transgender students from taking part in sports or using school facilities consistent with their gender identity.
The outing of transgender youth in schools to their parents.
On 16 June 2022, former Governor David Ige (D) signed into law the Gender Affirming Treatment Act (GATA), or HB 2405, which banned health insurers from limiting gender-affirming care that is medically necessary.
Health insurance providers were also mandated to provide clear information on coverage for gender transition services.
On 19 January 2024, legislators introduced HB 2079, authored by Rep. Jeanne Kapela (D) and other Democrats. The Bill passed the House on 5 March 2024, and its next step is to pass the Senate before being signed into law.
Island News reports that the Bill “aims to expand telehealth access to people seeking gender-affirming health services” and would stop out-of-state officials from breaking up families if a parent allowed a child to receive gender-affirming care.
There have been no notable lawsuits related to gender-affirming care in Hawaii, but the state’s various attorneys general have filed amicus briefs in support of such cases elsewhere in the US.
Hawaii’s Attorneys General have joined coalitions of states in filing amicus briefs over numerous transgender issues:
In October 2017, Attorney General Doug Chin joined 14 other attorneys general in filing an amicus brief against Trump’s ban on transgender individuals serving in the military.
In November 2019, Attorney General Clare E. Connors joined 22 other attorneys general in supporting transgender rights as part of an antidiscrimination lawsuit brought against a high school in Virginia.
In 2021, Hawaii was one of 20 states, along with D.C., to file an amicus brief supporting plaintiffs who challenged an Arkansas law that bans gender-affirming care for minors, bans medical providers from making referrals to other providers for children seeking gender-affirming care, and bans private insurance as well as public funds coverage of gender-affirming care for minors.
State Democrats say transgender care is part of a person’s right to choose, but local parents say HB 2079 is pressuring children into procedures without the consent of their parents.
Rep. Terez Amato (D), one of the primary sponsors of HB 2079, says transgender care is part of “a person’s right to choose”.
“These decisions are between a patient, their parents and their Doctor. HB 2079 protects medical personnel and does not in any way remove parental rights. Body autonomy is a human right. As a Democrat and a mother, I will always support a person's right to choose.”
Austin Martin, the Chair of the Hawaiian Libertarian Party (which isn’t notable), said of HB 2079 that:
“The Hawaii Kidnapping Bill (HB2079, ‘Relating to Health’) is among the worst proposed laws of this legislative session.”
“Awaiting Senate action after passing the House, HB2079 grants a de-facto immunity and asylum in Hawaii for any kidnapper who claims to be helping a child receive so-called ‘gender-affirming’ treatments.”
Only eight of Hawaii's 76 House and Senate seats are held by Republicans, and they have been quiet on the issue of transgender rights. Bob McDermott, a resident of Ewa Beach, spoke to Island News about HB 2079 and said,
“At 14, children are not allowed to go to R-rated movies or get tattoos, yet there is a push now to let them remove their breasts and other body parts without the consent of their own parents.”
There’s no significant polling on attitudes towards transgender issues.
Illinois
Illinois is considered one of America’s most progressive states when it comes to transgender care. The state has enacted a number of bills and laws that protect gender-affirming care, including from out-of-state litigation. The state also bans police from using license plates to track people coming to the state for care.
Illinois is considered a sanctuary state for transgender care. In January 2023, Governor Pritzker (D) signed House Bill 4664, which protects reproductive and gender-affirming care. It also protects patients, those assisting them, and healthcare providers from out-of-state litigation.
In August 2024, Governor Pritzker signed HB 5239, a shield law that bars state officials from giving information or resources to help any individual or out-of-state body that’s trying to bring criminal or civil liability for administering or receiving lawful health care, including gender-affirming and reproductive care.
House Bill 3326 (signed in 2023) made Illinois the first state in the US to ban police from using license plate readers to track people coming to Illinois for gender-affirming or reproductive care.
In June 2024, NPR Illinois announced that the new Transgender and Gender Diverse (TGD) Wellness and Equity Program would expand gender-affirming care in the state. The initiative would,
“Expand comprehensive and medically necessary care for transgender, gender-diverse, and LGBTQ+ people throughout Illinois. This program equips organizations that currently serve LGBTQ+ communities to increase their capacity to provide culturally- and medically-competent gender-affirming care.”
A 2021 ruling stated that transgender people in the state have the right to use bathrooms consistent with their gender identity, while in 2019, a group of parents dropped a nationally prominent lawsuit to keep transgender students out of bathrooms. In 2023, a judge ruled that Blue Cross Blue Shield of Illinois (BCBSIL) must stop excluding gender-affirming care from its health plans across America.
In April 2019, a group of Illinois parents dropped their four-year lawsuit to keep transgender students out of bathrooms and locker rooms that are consistent with their gender identity.
In a case that attracted national attention, the Washington Post reports that “Students and Parents for Privacy sued Township High School District 211 in Palatine, Ill., after the school board, facing pressure from the Obama administration, voted to allow a transgender girl to use the girls’ locker room.”
However, the group did not initially explain its decision to drop the case.
A federal appeals court is being asked to vacate court orders issued by a federal judge concerning an ongoing case about the evaluation and treatment of Illinois prisoners with gender dysphoria.
Monroe v. Bowman is a class action suit first filed in January 2018 on behalf of five women and all individuals in the custody of the Illinois Department of Corrections who have asked for evaluation or treatment for gender dysphoria.
In August 2021, the Second District Appellate Court of Illinois ruled in Hobby Lobby Stores, Inc. v. Sommerville (2021 IL App (2d) 190362) that transgender people in the state have the right to use restrooms consistent with their gender identity.
In December 2023, US District Judge Robert Bryan ruled that Blue Cross Blue Shield of Illinois (BCBSIL) must stop excluding gender-affirming care from its health plans across America.
Governor Pritzker has been keen to brandish his credentials as a trans ally, and along with his fellow Democrats, he is keen to describe Illinois as an “island” for gender-affirming and reproductive care.
Democrats have consistently described Illinois as an “island” for such care:
Pritzker said in January 2023 at the signing of House Bill 4664: “Last summer, when Roe v. Wade was overturned, I made a promise that Illinois would remain a beacon of hope and an island for reproductive justice for all who seek it. This bill fulfills that promise.”
Democratic Sen. Celina Villanueva said at the same time: “This legislation consolidates Illinois as an island that protects reproductive and gender-affirming rights in the Midwest. It places our state at the forefront of a nation for granting people the freedom to make their life decisions.”
Speaking on the signing of HB0009 in February 2023, which made it easier for individuals to change their gender on their birth certificate, Governor Pritzker said,
“Here in Illinois, we recognize that gender transition is a personal journey that doesn't always follow a prescriptive medical path, but still deserves to be honored legally. In a time of increasing violence and hateful rhetoric against the trans, nonbinary, and gender non-conforming community, it is more important than ever to reaffirm our state's commitment to recognizing the rights and dignity of LGBTQ+ Illinoisans.”
Attorney General Kwame Raoul said at the passing of HB4664 that,
"The fight for access to reproductive and gender-affirming care does not end here. We must continue our work to ensure Illinois remains a healthcare oasis for anyone seeking care. In Illinois, we support a woman's right to choose, we support transgender youth and their families, and we support the medical professionals who perform these essential services every day.”
In August 2021, Governor Pritzker welcomed the ruling in Hobby Lobby Stores, Inc. v. Sommerville that declared transgender people in Illinois can use bathrooms consistent with their gender identity,
“I'm pleased to see the court recognize Hobby Lobby's stance against its employee as what it is: discrimination based on gender-identity. Ours is a welcoming and inclusive state, and the Illinois Department of Human Rights will go toe to toe with any employer or business that tries to treat individuals differently because of their identity.”
There’s no significant polling on attitudes towards transgender issues.
Kansas
Kansas is a red state with a blue governor, which means its legislature enacts laws banning various transgender policies, the governor then vetoes the laws, only for the legislature to (mostly) override the veto. Kansas defines male and female by biological sex and bans transgender athletes from women’s sports and bathrooms. In 2025, Kansas will likely ban gender-affirming care for minors
Kansas does not yet have laws banning or enshrining access to gender-affirming care.
On 27 April 2023, Ogletree Deakins reported that “the Kansas Legislature overrode Governor Laura Kelly’s (D) veto of Senate Bill (SB) 180, which defines 'male' and 'female' only by biological sex.”
The Kansas Senate describes SB 180 as a “women’s bill of rights” and does not provide alternative definitions for transgender individuals.
The law became effective on 1 July 2023.
In April 2023, Kansas also imposed what the AP described as “some of the nation’s broadest bathroom restrictions,” which banned transgender people from using bathrooms consistent with their gender identity.
Governor Kelly had blocked the law, but the legislature overrode her veto.
The Bill also ruled that, from 1 July 2023, transgender individuals in Kansas were also not able to change their driver’s license to match their gender identity.
In April 2023, Kansas also banned transgender athletes from competing in female sports from kindergarten through college.
On 5 April 2023, the Kansas Legislature again overrode a veto by Governor Laura Kelly, the third in three years, of a bill to ban trans athletes.
The law became effective from July 1, 2023, but The Beacon reports that schools and universities are ignoring the law.
In August 2023, US District Judge Daniel Crabtree ruled that Kansas officials no longer have to change transgender individuals’ birth certificates to match their gender identity.
In his verdict, Crabtree said, “The court has genuine misgivings about inserting itself into the dispute about the meaning of the new Kansas law, SB 180.”
In April 2024, Kansas Republicans failed by two votes to secure the two-thirds majority needed to overturn Governor Kelly’s veto of a bill that would’ve banned gender-affirming care for minors and banned state employees who work with children from pushing gender transitioning.
But in December 2024, the Kansas City Star reported that state Republicans want to ban gender-affirming care for minors in 2025. The outlet reports that with expanded supermajorities in the House and Senate, Republicans are confident that the measure will be passed.
The Human Rights Campaign reports the full list of Governor Kelly’s relevant vetoes as follows:
“SB 26: Similar to SB 233, prohibits transgender youth from receiving gender-affirming care.”
“SB 180: Applies a definition of gender discriminating against transgender individuals.”
“SB 228: Requires individuals to use restrooms aligning with their gender assigned at birth.”
“HB 2128: Forces misgendering in overnight and jail cell accommodations for transgender Kansans”
“HB 2238: Bans the participation of transgender student athletes in school sports”
Kansas v. Harper is an ongoing case challenging the AG’s decision for the state to issue driver’s licenses with a gender marker indicating biological sex. A Kansas district judge blocked a Biden administration rule that would have purportedly protected LGBTQ+ students from discrimination. Teachers in two notable cases also sued their school districts over issues related to students’ pronouns.
In July 2024, US District Judge John Broomes (based in Kansas) blocked a Biden administration rule that would have purportedly protected LGBTQ+ students from discrimination in schools and colleges.
Broomes’ block applies to Kansas, Alaska, Utah, and Wyoming. Broomes also blocked the rule for all K-12 schools and colleges attended by children of members of Moms for Liberty, Young America’s Foundation, and Female Athletes United.
Kansas v. Harper is an ongoing case in which five transgender individuals in Kansas are challenging the Kansas AG’s (Kris Kobach) decision to “require the state to issue driver’s licenses with a gender marker that reveals their sex assigned at birth.”
Jennifer Caedran Sullivan, a Kansas high school teacher, is suing her school district for violating her freedom of speech and religion after she opposed diversity and inclusion training, as well as gender ideology. Sullivan published an op-ed for Fox News on the case.
In 2022, a teacher was awarded a $95,000 settlement with her school district after she was suspended for three days with pay for violating 11 district policies. Pamela Ricard cited her religious beliefs in refusing to refer to students by their chosen pronouns and names.
Kansas Republicans are resolute in fighting against transgender issues, but Governor Laura Kelly uses the issue of parental rights to veto such legislation.
Governor Kelly explained her veto of bills to ban gender-affirming care by saying,
“To be clear, this legislation tramples parental rights. The last place that I would want to be as a politician is between a parent and a child who needs medical care of any kind. And, yet, that is exactly what this legislation does.”
Senate President Ty Masterson, an Andover Republican, told reporters in December 2024 to expect a new bill banning transgender care for minors:
“Trans surgeries on minors? It will be back. We only missed that by one or two votes in the House, right? (The Senate) overrode it then and I think this caucus is probably stronger in that opinion than the prior one. So that would definitely be back.”
House Speaker Dan Hawkins (R) said people in Kansas overwhelmingly support measures to ban minors from getting gender-affirming care:
“It’s a priority for the people.”
There’s no significant polling on attitudes towards transgender issues.
Kentucky
Kentucky’s transgender-specific policies typically relate to minors and students. Kentucky is a red state with a blue governor, so like Kansas, the state legislature often overrides the governor’s vetoes on related bills.
Kentucky Republicans passed Senate Bill 150, which bans transgender minors from getting gender-affirming care like hormone therapies and puberty blockers. The bill also bans transgender students from using bathrooms, showers, and locker rooms consistent with their gender identity.
On 24 March 2023, Governor Andy Beshear (D) vetoed the bill, but the GOP legislature overruled his decision.
US District Judge David Hale temporarily blocked the restrictions in June 2023 but lifted the injunction the following month.
In September 2023, the 6th U.S. Circuit Court of Appeals ruled in a 2-1 decision that Kentucky and Tennessee can continue to ban gender-affirming care for minors.
In June 2024, the Supreme Court announced that it would review the Sixth Circuit’s decision, and the pending decision will impact Senate Bill 150.
In 2022, Kentucky passed Senate Bill 83, also known as the Fairness in Women’s Sports Act, which bans transgender students from taking part in school sports according to their gender identity.
Governor Beshear vetoed the anti-trans sports ban in April 2022, but the Republican-controlled legislature overruled the veto the following week.
Kentucky does not have laws banning transgender individuals from using bathrooms and school facilities consistent with their gender identity.
Kentucky does not explicitly define sex in state law to potentially exclude transgender individuals, it does not have so-called “shield” laws in place, and the state does not force schools to out transgender students.
A Supreme Court decision is pending on United States v. Skrmetti, which relates to Kentucky’s Senate Bill 150, but Tennessee is the state specifically mentioned. Kentucky families have also filed a class action lawsuit challenging Senate Bill 150. Meanwhile, a professor at the University of Louisville won a free speech case following his dismissal for cautioning against transgender care for minors.
The Supreme Court is currently reviewing the Sixth Circuit decision to ban transgender minors from receiving gender-affirming care. United States v. Skrmetti specifically concerns Tennessee’s ban on gender-affirming care for minors, but the result will impact Kentucky’s Senate Bill 150.
Doe v. Thornbury - The families of five transgender and nonbinary students filed a class action lawsuit in Fayette County Circuit Court. The plaintiffs said that Senate Bill 150 violated students’ right to privacy and public education as protected by the state constitution. The case was the first legal challenge against Senate Bill 150.
US District Judge David Hale temporarily blocked the restrictions in June 2023 but lifted the injunction on 31 July 2023.
In September 2024, a Kentucky child psychiatrist and professor won a free speech lawsuit against the University of Louisville.
Dr. Allan Josephson was the head of the university’s Division of Child and Adolescent Psychiatry, but in 2017, he expressed caution about gender treatment for minors and was fired two years later.
Kentucky Republicans have pushed through legislation in the name of protecting children from irreparable harm. Governor Andy Beshear has tried to frame his vetoes as a defense of parental rights and protecting children, rather than specifically defending LGBTQ rights.
The Senate majority caucus said that Senate Bill 150 will protect children:
“from the irreparable harm of gender-affirming care – including gender reassignment surgery which involves genital mutilation – before a child can fully consent to the potential ramification of such a life-altering decision.”
Governor Andy Beshear vetoed Senate Bill 150 and explained his decision in a statement released on 24 March 2023.
“Senate Bill 150 allows too much government interference in personal healthcare issues and rips away the freedom of parents to make medical decisions for their children.”
“I am also vetoing Senate Bill 150 because my faith teaches me that all children are children of God and Senate Bill 150 will endanger the children of Kentucky. In a 2022 National Survey on LGBTQ youth mental health, 45% of LGBTQ youth seriously considered suicide in the past year and nearly 1 in 5 transgender youth attempted suicide.”
In July 2023, in response to Republican attacks, Governor Beshear tried to save face on the issue ahead of the gubernatorial race in November 2023,
“My position on this has always been clear. I have never supported gender reassignment surgery for minors, and they don’t happen in Kentucky.”
Kentucky’s Democratic Party said Senate Bill 150 is the:
“Most extreme anti-LGBTQ bill in America.”
A poll conducted in January 2023 purported to show an overwhelming majority of people in Kentucky opposed Senate Bill 150.
A poll conducted in January 2023 revealed that 71% of people in Kentucky opposed the (then proposed) law to allow the state to ban gender-affirming care for minors.
“Would you support or oppose a proposed Kentucky law that would allow the state to overrule parents’ decisions to obtain certain health care for their transgender teenager, such as certain medications that can regulate the onset of puberty?”
Maine
In 2023, Maine passed a bill to allow individuals aged 16 and over to receive non-surgical gender-affirming hormone therapy without their parents' consent. The following year, Maine passed a shield law protecting healthcare professionals. But Maine is not a transgender refuge/sanctuary state after Democrats unanimously struck down a bill following social media pressure from right-wingers.
In April 2024, Maine passed LD 227, and the bill took effect on 9 August of that year. The shield law protects health care professionals who provide legal gender-affirming and reproductive care from out-of-state legal action.
The law also expands an existing program that lets providers of protected health care make their addresses confidential.
The Maine Senate voted 21-13 while the House voted 76-67.
Maine has codified the right to gender-affirming and reproductive care in the state.
H.P. 340 - L.D. 535 passed in 2023 and permits people aged 16 and over to receive non-surgical gender-affirming hormone therapy without their parents’ consent under a set of specific circumstances.
Maine does not have any specific laws enshrining or opposing the right of transgender individuals to use bathrooms or other facilities, play sports, or to out transgender youth in schools to their parents.
In January 2024, Maine Democrats unanimously voted to strike down LD 1735 to make the state a sanctuary for transgender people. The bill would’ve protected gender-affirming care for transgender individuals, including minors.
Commentators say Democrats decided to kill their own bill in response to social media campaigns from right-wingers.
A state court in Maine was the first in the country to rule it illegal to deny students access to a bathroom consistent with their gender identity. In 2024, a Maine mother took legal action against a school district for hiding details of her 13-year-old daughter’s gender transition.
In March 2024, 16 Republican state attorneys general threatened legal action against Maine if LD 227 passed, but they have not followed through on their threat.
In October 2024, a federal appeals court in Boston heard the case of a mother from Maine who alleged that a school district hid her thirteen-year-old daughter’s attempted gender transition. A school counselor gave the girl a chest binder and instructions on how to use it, while the school began using the girl’s preferred name and pronouns.
U.S. District Judge Jon Levy dismissed the case in May 2024.
In June 2013, the Maine Supreme Judicial Court decided the landmark case Doe v. Regional School Unit 26.
The court ruled in favor of a transgender student at a high school wishing to use a female bathroom consistent with their gender identity. This was the first time a state court ruled that denying student access to a bathroom over gender identity was unlawful.
Maine has a strong Republican contingent that has used heated language around abuse and even divine retribution when criticizing the state’s transgender laws. Meanwhile, Democrats accuse Republicans of exaggerating the extent of the state’s laws.
Democratic Rep. Sam Zager (who is a physician) criticized the idea that minors are taken to blue states to receive gender-affirming care on a whim,
“This is not somebody whisked away for a weekend making a declaration and having surgery. It is very deliberate and very meticulous and is not done expediently.”
Rep. Reagan Paul (R-Winterport) said on the signing of LD 227 that,
“This bill is not about access to health care. This bill is about empowering abusers.”
Maine Republican Chair Joel Stetkis said of LD 227,
“It should be no surprise to anyone, who has been paying attention, that Janet Mills and the Democrats in Augusta continue to carry the water for the radical special interest groups that have put them in power. LD 227 is just the latest unconscionable idea that the government knows better than the parents of minor children and that Democrat politicians have zero interest in listening to the Maine people.”
In a heated debate, AP reports that:
“Rep. Michael Lemelin, R-Chelsea, said the mass shooting last October in Lewiston, Maine, that claimed 18 lives and recent storms were God’s revenge for “immoral” laws adopted by legislators, and he described the shield bill as “inspired by Lucifer himself.”
There’s no significant polling on attitudes towards transgender issues.
Maryland
Maryland is a transgender care sanctuary state, and Governor Wes Moore has signed several bills protecting gender-affirming care in the state.
In June 2023, Governor Moore signed an executive order protecting gender-affirming care in the state. Anyone administering or receiving gender-affirming care is protected from out-of-state legal action.
House Bill 691 is Maryland’s Trans Shield Act and went into effect on 1 October 2024. The bill protects patients and medical providers from out-of-state legal action and adds certain gender-affirming care options to the state’s list of legally protected health care.
The bill was first passed by the Maryland Senate and then approved by the House of Delegates in April. Governor Moore signed it into law the following month.
The bill affirms Maryland’s status as a sanctuary state.
On 3 May 2023, Governor Wes Moore (D) signed House Bill 283, known as the Trans Health Equity Act, which mandates that Medicaid must cover gender-affirming care, including surgeries and hormone therapy. The law went into effect on 1 January 2024.
Effective from 1 January 2023, Senate Bill 460 requires that the Maryland Medical Assistance Program assess and provide gender-affirming care in a non-discriminatory manner.
The Supreme Court declined to hear a case challenging a Maryland school district’s policy not to notify parents if their child identifies as transgender without the student’s consent. Maryland courts have ruled in favor of transgender individuals denied access to school facilities consistent with their gender identity and denied a hysterectomy at a Catholic hospital.
In May 2024, the Supreme Court declined to hear a case challenging a Maryland school district’s policy not to notify parents if their child identifies as transgender without the student’s consent.
Three parents sued the Montgomery County Board of Education in 2020, saying that the policy violated their 14th Amendment rights.
US District Judge Paul Grimm threw out the case in 2022, while the following year, a three-judge panel of the 4th US Circuit Court of Appeals upheld the dismissal by two votes to one.
On 6 January 2023, a Maryland federal court awarded a summary judgment to Jesse Hammons, a transgender man, after Hammons was denied a hysterectomy at the University of Maryland St. Joseph Medical Center, a Catholic hospital.
The hospital denied Hammons the procedure because it was gender-affirming and in violation of Catholic directives.
In March 2018, M.A.B. v. Board of Education of Talbot County ruled that transgender students can’t be banned from sex-segregated bathrooms and locker rooms that are consistent with their gender identity.
Max Brennan, a 16-year-old transgender high school student, filed a suit after Brennan was barred from using the facilities.
Maryland Democrats have cited laws in red states as justification for their transgender-related bills. Maryland Republicans have referred to gender-affirming care as "mutilation" and criticized Democrats for not protecting children.
Governor Wes Moore said at the signing of a June 2023 executive order that protected gender-affirming care,
“In the State of Maryland, nobody should have to justify their own humanity. This order is focused on ensuring Maryland is a safe place for gender-affirming care, especially as other states take misguided and hateful steps to make gender-affirming care cause for legal retribution. In Maryland, we are going to lead on this issue.”
Del. Kris Fair (D-Frederick), chair of the LGBTQ+ Caucus, said in May 2023,
“We should not be in the business of telling low-income or impoverished people that they don’t deserve access to the same level of care that every other Maryland resident has access to. Current political environments across the country are pushing back against the idea that people have the right to identify as transgender. This will simply reaffirm Maryland’s commitment to its trans community.”
Del. Mark N. Fisher (R-Calvert) said during a March 2023 debate that,
“The goal here is to get the taxpayers to pay for these mutilation services.”
Del. Lauren Arikan (R-Harford) said in March 2023, as delegates voted down an amendment to weaken the law,
“Down the road, people in here with a deep conscience will regret how they behaved today. There will be someone in your office crying because of what happened to them asking you, ‘Why didn’t you protect me?’”
A majority of voters in Maryland don’t support public school teachers discussing tolerance of LGBTQ individuals with elementary school pupils. A plurality believes greater acceptance of transgender people is good for society.
A majority of voters say it’s inappropriate for public school teachers to discuss acceptance of LGBTQ people to kids up to and including 5th grade.
A plurality of Maryland voters believe greater acceptance of transgender people is good for society.
Massachusetts
Massachusetts is a transgender sanctuary state, and its signature bill on the matter was signed by former Republican Governor Charlie Baker. Leading Democrats in Massachusetts have since reaffirmed the state’s commitment to transgender healthcare rights.
Former Governor Charlie Baker (R) signed HB 5090, “An Act Expanding Protections for Reproductive and Gender-Affirming Care”, on 29 July 2022.
The Act protects health care providers and the recipients of gender-affirming care from out-of-state legal action.
The act also protects in law access to gender-affirming and reproductive care.
Massachusetts is considered a sanctuary state for transgender people. At a June 2023 roundtable discussion, Governor Maura Healey and Lieutenant Governor Kim Driscoll declared that Massachusetts is a safe haven for transgender people and their families.
The pair made the announcement in response to legislation in red states restricting transgender rights.
St. 2016, c. 134 is an act that mandates transgender people are allowed to use restrooms and other facilities consistent with their gender identity.
MGL c. 111, § 72GG will be effective from 3 June 2025 and will ban,
“Discrimination against residents of long-term care facilities on the basis of a person's actual or perceived sexual orientation, gender identity, gender expression, intersex status or HIV status; ensures that records reflect the name, gender, and pronouns by which a resident would like to be identified; also provides for transition-related assessments, therapy and treatments for transgender residents.”
Massachusetts does not require schools to out transgender students to their parents, nor does the state explicitly define sex in law.
Massachusetts lawsuits have consistently ruled against plaintiffs challenging the transgender status quo. A judge dismissed a case brought by a boy who was sent home after wearing a t-shirt proclaiming there to be two genders. Meanwhile, a judge dropped a suit brought by parents after a school hid their children’s gender identities.
A federal judge is considering whether to dismiss a lawsuit filed by a Massachusetts teacher who was fired for outing a student to her parents.
Bonnie A. Manchester was fired in 2021 after telling a student’s parents that the 11-year-old was gender fluid and asked to be referred to by different pronouns and a new name.
On 14 December 2022, a federal judge dismissed the lawsuit Foote, et al. v. Town of Ludlow, et al., No. 22-30041 (2022). The suit was filed by two parents against Ludlow Public Schools after they hid their children's gender identities in 2021.
In June 2024, the 1st US Circuit Court of Appeals ruled that a Massachusetts public middle school did not, according to Reuters,
“violate a student's free speech rights under the U.S. Constitution by requiring the boy to stop wearing a T-shirt that said "There are only two genders.”
In April 2023, educators told Liam Morrison, a student at Nichols Middle School in Middleborough, to take off the shirt or leave for the day. Morrison chose to leave.
The ongoing Moms for Liberty lawsuit against the expansion of Title IX affects 32 schools in 19 districts in Massachusetts. The suit affects over 2,000 schools nationwide.
In December 2016, four Massachusetts churches dropped a lawsuit against the state in which they claimed a new transgender anti-discrimination law violated their religious freedoms. The law forced churches to allow transgender people to use facilities consistent with their gender identity.
Governor Healey and Lieutenant Governor Driscoll both reaffirmed Massachusetts’ status as a safe haven for transgender people following a series of bills in red states against transgender rights.
Governor Maura Healey declared in a June 2023 meeting that Massachusetts is a safe haven for transgender people and their families.
“Gender-affirming care is a fundamental right and a critical health care need. Our Administration will continue to do everything in our power to protect our patients and providers, because we know that gender-affirming care is life-saving care. Massachusetts is, and will continue to be, a safe haven – for clinicians, for transgender and non-binary folks, and for the people who love them.”
Lieutenant Governor Kim Driscoll said at the same meeting,
“Gender-affirming care remains legal and protected in Massachusetts. Despite constant threats, challenges, and attacks on their professional and personal lives, Massachusetts’ gender-affirming care physicians and advocates have continued to provide essential care for those who need it. Our commitment to protect access to this care starts with protecting the people who provide it. Massachusetts will continue to lead the nation in these measures.”
Two-thirds of people in Massachusetts voted in a referendum to uphold a law banning discrimination against people using public facilities consistent with their gender.
In 2018, by 67.82% to 32.18%, voters in the Massachusetts Gender Identity Anti-Discrimination Initiative chose to maintain a state law that bans discrimination against people using public facilities consistent with their gender identity.
Michigan
Michigan is not a transgender sanctuary state, and its laws generally do not enshrine transgender rights or discriminate. Transgender students can use bathrooms consistent with their gender identity because state law prevents discrimination based on gender identity.
Michigan civil rights law requires that transgender students be allowed to use bathrooms and other school facilities consistent with their gender identity.
In March 2023, Governor Gretchen Whitmer (D) signed Senate Bill 4, which expanded the Elliot-Larsen Civil Rights Act to reaffirm “legal protections for sexual orientation and expand coverage to include gender identity and expression.”
In July 2023, Governor Whitmer signed House Bills 4616 and 4617 banning conversion therapy for LGBTQ+ youth.
State employees don’t enjoy transgender-inclusive health benefits, but health providers are banned from excluding coverage for transgender care. Michigan does not have shield law protections for gender-affirming care and is not considered a sanctuary state.
The two most notable cases involved parents suing school districts for hiding their daughter’s transition and for allowing students to use bathrooms consistent with their gender identity. A group of Catholic counselors is also suing the state over its conversion therapy ban.
In late 2023, Dan and Jennifer Mead sued Rockford Public School District after learning that the school had been covering up their daughter’s social transition. Mrs Mead says they had been seeking academic help for their daughter from a school counselor,
“And all this time, they were lying to us, changing records. They were calling her by a male name, a masculine pronoun at school, and then when they would talk to us or send anything home, it was always her, you know… her given name.”
It was only in October 2022 when a school psychologist accidentally included their daughter’s masculine name in a section of a report that the Meads learned their eighth-grader had socially transitioned.
Mead v. Rockford Public School District is ongoing.
In August 2023, parents filed a lawsuit against Vicksburg Community Schools for allowing students to use bathrooms and other facilities consistent with their gender. Local news reports that the case “accused the district of seven civil rights and Title IX violations.”
The district argued that it was following federal guidance and a Michigan law that allows people to use facilities consistent with their gender identity.
However, on 4 October 2024, the plaintiffs filed to withdraw the case over a breakdown in the attorney-client relationship, and the case was dismissed on 7 October.
A group of Catholic counselors is suing Michigan over its conversion therapy ban for minors, specifically HB 4616. The plaintiffs say the law restricts their ability to counsel minors dealing with their gender identity. Catholic Charities v. Whitmer was filed in July 2024.
Governor Whitmer has made generic comments about Michigan being an inclusive place for LGBTQ+ people.
Governor Whitmer said in a press release banning conversion therapy for minors,
“Today, we are banning the horrific practice of conversion therapy in Michigan and ensuring this is a state where you can be who you are. As a mom of a member of the community and a proud, lifelong ally, I am grateful that we are taking action to make Michigan a more welcoming, inclusive place.”
