Idaho considers a ban on using public funds or facilities for gender-affirming care
BOISE, Idaho– Idaho lawmakers are expected to vote this week on a bill that would ban the use of public funds for gender-affirming care, including for state workers who use health insurance and for adults covered by Medicaid.
The legislation has already passed the House of Representatives and only needs to be approved by the Republican Senate majority before being sent to Governor Brad Little’s desk, where it will likely be signed into law. The Republican governor has repeatedly said he does not believe public funds should be used for gender-affirming care.
If the legislation passes, Idaho would become at least the 10th state to ban Medicaid funding for gender-affirming care for people of all ages, according to the advocacy and information organization Movement Advancement Project. The laws are part of an ongoing national fight for the rights of LGBTQ+ Americans.
Opponents of the Idaho bill say it will almost certainly lead to a lawsuit in federal court. The state has been sued several times over attempts to deny gender-affirming care to transgender residents and has not had much success defending the lawsuits so far.
In one case, the state was ordered to give a transgender prisoner gender transition surgery, and the prisoner was later awarded approximately $2.5 million in legal fees.
Last year, a federal judge barred Idaho from enforcing its recently enacted ban on gender-affirming medical care for minors until a lawsuit brought by transgender youth and their families was resolved. Another federal judge denied the state’s request to dismiss a separate lawsuit filed in 2022 by adults who said Medicaid officials improperly denied coverage for their medically necessary gender-affirming treatment.
“This bill violates the Equal Protection Clause of the 14th Amendment” and the federal Medicaid Act, Boise attorney Howard Belodoff told lawmakers at a hearing Thursday.
Belodoff represents the transgender adults who have sued the state over what they say were discriminatory Medicaid policies that excluded coverage for genital reconstruction surgery.
“You cannot distinguish between providing care based on diagnosis, type of disease or condition,” Belodoff said. “That is exactly what this bill does: it conflicts with the Medicaid Act.”
One of the bill’s sponsors, Republican Rep. Bruce Skaug, said these lawsuits prompted the bill’s creation.
“This, in my opinion, is a taxpayer protection bill,” Skaug said, suggesting that without it, the state could end up paying millions for gender-affirming care. About 70% of Idaho’s Medicaid program is federally funded.
Some who testified against the bill suggested it could have a much wider reach than intended by eliminating gender-affirming care for even privately insured residents living in rural areas with only state-funded medical centers.
Isaac Craghtten, an employee of the Idaho Department of Correction, noted that many correctional employees work 12- to 16-hour shifts, which may require taking certain prescription medications such as hormone therapy while on the job.
But the legislation prohibits the use of state property, facilities or buildings to perform surgical operations or medical procedures, which could mean employees would face criminal penalties for taking their own legally prescribed medications in a break room, Craghtten said.
The penalty for violating the law would include fines ranging from $300 to $10,000 and a prison sentence of one to 14 years.
At least 23 states, including Idaho, have passed laws banning gender-affirming care for minors. Some states have also considered policies that experts say would make it more difficult for transgender adults to receive care, such as eliminating telehealth options or requiring repeated psychological exams for continued gender-affirming treatment.
Major medical groups, including the American Medical Association and the American Academy of Pediatrics, oppose gender-affirming care bans and have endorsed such care, saying it is safe when administered properly.
While courts have blocked enforcement of gender-affirming care bans for minors in Idaho, Montana and Arkansas, they have allowed enforcement in Alabama and Georgia.
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Associated Press writers Geoff Mulvihill in Cherry Hill, New Jersey, Hannah Schoenbaum in Salt Lake City and John Hanna in Topeka, Kansas, contributed to this report.