As the U.S. continues its war on transgender healthcare, the divide between states is more dramatic than ever. While some states criminalize gender-affirming care, others have become safe havens for transgender individuals, their families, and healthcare providers. Below is a comprehensive breakdown of the 10 worst states attacking trans healthcare and the 10 best states actively protecting it in 2025.
1. Alabama: Felony Charges for Doctors, Parents at Risk
Alabama has some of the most extreme penalties for transgender healthcare in the country. Lawmakers in the state have actively worked to criminalize gender-affirming care, going beyond bans to include criminal charges against doctors and potential legal consequences for supportive parents.
- Ban Details: SB 184 makes it a felony for doctors to prescribe puberty blockers or hormones to minors.
- Enforcement: Doctors face up to 10 years in prison for treating trans youth.
- Parental Rights Threatened: Parents who support gender-affirming care could lose custody or face child abuse allegations.
- Current Status: The law is active, and court challenges have failed to block it.
2. Texas: Criminalizing Healthcare & Investigating Families
Texas has been at the forefront of anti-trans legislation, with its policies actively targeting both trans youth and their families. The state has implemented multiple laws restricting access to care and enabling child protective services to investigate families who seek medical treatment for their trans children.
- Ban Details: SB 14 bans gender-affirming care for minors and empowers the state to investigate parents for child abuse.
- Enforcement:
- Doctors lose their medical licenses if they provide care.
- State investigations into families continue under Governor Greg Abbott.
- Current Status: Fully enforced, forcing families to leave the state.
3. Florida: Bans for Youth & Restrictions for Adults
Florida has gone a step further than many states by restricting both youth and adult access to gender-affirming care. The law makes it more difficult for adults to receive treatment by imposing unnecessary bureaucratic obstacles.
- Ban Details: SB 254 bans care for minors and severely restricts care for transgender adults, requiring in-person doctor visits and blocking nurse practitioners from prescribing HRT.
- Enforcement:
- Felony charges for doctors treating minors.
- Insurance exclusions prevent some adults from getting covered care.
- Current Status: Struck down by a federal judge in 2024, but Florida is appealing in court.
4. Oklahoma: One of the Harshest Criminal Penalties
Oklahoma has aggressively targeted trans youth, not just banning care but also criminalizing medical professionals who provide treatment. The state’s laws make it one of the most dangerous places for trans youth seeking medical care.
- Ban Details: SB 613 bans all gender-affirming medical care for minors.
- Enforcement:
- Doctors face felony charges (up to 10 years in prison).
- Parents face potential child abuse allegations for supporting transition.
- Current Status: Active law with no legal challenges blocking it.
5. Tennessee: Supreme Court Case Could Set National Precedent
Tennessee is one of the first states to have its anti-trans laws challenged in the Supreme Court. A ruling in favor of the state could solidify bans nationwide.
- Ban Details: SB 1 bans care for minors and imposes a $25,000 fine per violation on doctors.
- Enforcement: No puberty blockers, hormones, or surgery for minors.
- Current Status: The law is active, and the Supreme Court will rule on its constitutionality in mid-2025.
6. Idaho: Criminalizing Healthcare & Travel Restrictions
Idaho has enacted some of the strictest travel bans, criminalizing parents who seek care for their trans children out of state.
- Ban Details: House Bill 71 criminalizes gender-affirming care for minors.
- Enforcement:
- Doctors face felony charges for providing care.
- Parents who take their child out of state for care could be investigated.
- Current Status: The Supreme Court allowed the law to go into effect in 2024.
7. Missouri: Medicaid Bans & Civil Lawsuits Against Doctors
Missouri is one of the few states where adults have also been impacted, as Medicaid no longer covers gender-affirming care.
- Ban Details: SB 49 bans youth care and allows former trans patients to sue doctors for malpractice for up to 15 years.
- Enforcement:
- Medicaid no longer covers trans healthcare in Missouri.
- Doctors face automatic malpractice lawsuits if a patient later regrets transitioning.
- Current Status: The ban took effect in August 2023 and remains in place.
8. Arkansas: The First State to Ban Trans Care (But Facing Legal Setbacks)
Arkansas was the first state to completely ban trans healthcare for minors, setting the stage for other states to follow.
- Ban Details: The SAFE Act bans all gender-affirming care for minors.
- Enforcement:
- Doctors lose their medical licenses for violating the ban.
- Civil lawsuits can be filed against providers for up to 15 years.
- Current Status: A federal judge struck down the ban in 2023, but Arkansas is appealing.
9. Kentucky: Harsh Restrictions With No Exceptions
Kentucky’s law prevents even referring transgender individuals to out-of-state care, limiting options further.
- Ban Details: SB 150 bans all care for minors and makes it illegal to provide any referrals for out-of-state care.
- Enforcement:
- Doctors can lose their medical licenses.
- State Attorney General has the power to shut down clinics.
- Current Status: The ban is fully enforced after the Sixth Circuit upheld it.
10. South Carolina: Newest Ban With Harsh Medicaid Exclusions
South Carolina has some of the strictest Medicaid exclusions, preventing even adults from receiving covered care.
- Ban Details: HB 4624 bans trans care for minors and blocks Medicaid from covering gender-affirming care for trans adults.
- Enforcement:
- Felony charges for doctors.
- Medicaid no longer covers trans-related medical care.
- Current Status: Partially blocked by a judge for adults, but the youth ban is in effect.
The 10 Best States for Transgender Healthcare Access
While some states are restricting access, others have taken bold action to protect transgender individuals. These states have passed shield laws, expanded healthcare coverage, and strengthened legal protections for trans residents.
1. California: The Gold Standard for Trans Rights
California has become a leading refuge for transgender healthcare, providing legal protection and full medical coverage for gender-affirming care.
- Shield Law: Prevents California from assisting other states in prosecuting trans individuals or healthcare providers.
- Healthcare Coverage: All insurance providers must cover trans care, including puberty blockers, HRT, and surgeries.
2. Minnesota: A Refuge in the Midwest
Minnesota has positioned itself as the primary trans refuge in the Midwest, offering strong legal and medical protections.
- Shield Law: Prevents law enforcement from helping other states enforce anti-trans laws.
- State-funded programs ensure accessible gender-affirming care.
3. Colorado: Expanding Insurance & Legal Protections
Colorado has not only protected trans healthcare but actively expanded Medicaid coverage for gender-affirming care.
- Shield Law: Protects trans people and doctors from out-of-state prosecution.
- Medicaid & Insurance Coverage: Trans healthcare is fully covered under state law.
4. Washington: A West Coast Haven
Washington State has passed some of the strongest legal protections for trans individuals, ensuring access to gender-affirming care without discrimination.
- Shield Law: Prevents extradition of doctors and families seeking care.
- Medicaid Coverage: Trans care is fully funded by the state.
5. New York: Strong Legal Protections
New York has ensured full coverage for gender-affirming care under both Medicaid and private insurance while also offering legal protections.
- Shield Law: Protects patients and healthcare providers from out-of-state legal action.
- Healthcare Coverage: Must cover gender-affirming care, including mental health support.
6. Oregon: One of the Most Comprehensive Trans Healthcare Systems
Oregon has one of the most inclusive healthcare systems in the U.S. for transgender individuals.
- Healthcare Mandates: Oregon requires all private insurance and Medicaid to cover gender-affirming care.
- State Funding: Oregon funds clinics specifically for trans patients.
7. Illinois: Midwest Safe Haven
Illinois is a key refuge for transgender individuals in the Midwest, offering strong legal and medical protections.
- Shield Law: Protects doctors and patients from out-of-state investigations.
- Healthcare Coverage: Gender-affirming care is covered under state insurance policies.
8. Massachusetts: A Leader in Trans Rights
Massachusetts has expanded Medicaid and state insurance to ensure universal access to trans healthcare.
9. Vermont: Protecting Trans Healthcare Access
Vermont has implemented robust legal protections and expanded insurance coverage, making it one of the safest places for trans individuals.
10. New Mexico: Expanding Legal & Healthcare Access
New Mexico has adopted progressive policies ensuring all trans residents have access to affordable healthcare.
Federal Government Actions Under the Second Trump Administration
The return of Donald Trump to the presidency in January 2025 has significantly impacted transgender healthcare rights at the federal level. With guidance from the conservative Project 2025 roadmap, his administration is actively working to restrict access to gender-affirming care through executive actions, legal reversals, and policy changes.
Executive Order Cutting Federal Funds
On January 28, 2025, Trump signed an executive order barring federal funds from supporting gender-affirming care for minors, directing agencies like the Department of Health and Human Services (HHS) to cut Medicaid funds, research grants, and health subsidies for providers. Hospitals fearing loss of funding began canceling trans youth appointments, leading to immediate lawsuits by civil rights groups. On February 13, a federal judge temporarily blocked enforcement, but the administration is expected to appeal, leaving the situation in flux.
Department of Justice (DOJ) Reversals
Under Biden, the DOJ supported legal challenges to state bans on gender-affirming care, arguing they violated federal law. Under Trump, the DOJ switched sides, now defending state bans in major cases like Tennessee’s Supreme Court battle and Arkansas’s appeal. This shift means legal fights are now lacking federal support and facing an emboldened DOJ arguing against trans rights.
Federal Legislation Threats
With a Republican-controlled Congress, lawmakers are pushing for a nationwide ban on gender-affirming care for minors. The Protect Children’s Innocence Act, previously introduced by Rep. Marjorie Taylor Greene, is being revived and could override state protections. Senate Republicans are also seeking to restrict Medicare and VA healthcare coverage for trans adults. While a full ban faces Democratic opposition, there’s a real possibility of restrictions being attached to key federal legislation.
Administrative Policy Rollbacks
Beyond legislation, Trump’s agencies are moving to restrict care through federal regulations:
- HHS is expected to roll back healthcare discrimination protections, removing gender identity from anti-discrimination rules.
- CMS (Centers for Medicare & Medicaid Services) may allow states to exclude gender-affirming care from Medicaid.
- The FDA could impose new restrictions on puberty blockers and HRT, limiting access through drug regulations.
Impact on the Military & Federal Employees
Trump has already signed an order banning trans athletes from federally funded schools, with potential military and federal employee healthcare exclusions next. The administration is also considering reinstating the ban on transgender military service and removing transition-related coverage from federal insurance plans.
Project 2025 Influence & Rhetoric
The Heritage Foundation’s Project 2025 is driving many of these policies, pushing to eliminate federal offices supporting LGBTQ+ health and branding gender-affirming care as harmful. Trump’s team has adopted inflammatory rhetoric, referring to trans healthcare as “child mutilation”, which has further emboldened states to enforce harsher bans.
Despite these actions, legal challenges and advocacy efforts are actively pushing back. Court rulings have already paused enforcement of Trump’s funding ban, and states like California and New York are leading legal efforts to counter federal rollbacks. The fight for trans healthcare has shifted to new battlegrounds, and ongoing legal challenges will determine the future of access at both state and federal levels
Resources, Support, and Ways to Take Action
Navigating the legal and medical landscape can be overwhelming, but you are not alone. There are organizations, strategies, and advocacy efforts that can help trans individuals and families fight back against restrictive laws and continue accessing necessary care.
Know Your Rights & Legal Assistance
Organizations like the ACLU, Lambda Legal, Transgender Law Center, and Advocates for Trans Equality provide state-specific guides explaining legal rights, travel options, and what to do if faced with discrimination or government intervention. If your rights are violated—such as a doctor refusing care or a pharmacist denying medication—contact legal groups like GLAD, TLDEF, or your state’s Equality organization for confidential legal advice and possible representation.
Accessing Medical Care Across State Lines
Despite state bans, it is legal to travel for gender-affirming care. Safe states like Minnesota, Colorado, and California offer care to out-of-state patients, with some clinics providing expedited services. Telehealth providers like Folx and Plume can sometimes prescribe HRT if patients are physically located in a state where care is legal. Financial assistance may be available through groups like Trans Lifeline Microgrants and local LGBTQ+ organizations.
Medication Access & Safety Planning
For those in hostile states, consider discussing 90-day prescriptions with your provider in case of sudden restrictions. Some individuals have safely accessed medications via informed-consent clinics, compounding pharmacies, or international sources, though medical guidance is recommended. Online communities like r/transhealth on Reddit share resources for safely navigating medication access.
Mental Health & Crisis Support
Legislative attacks can take a toll on mental well-being. The Trevor Project provides crisis counseling for LGBTQ+ youth, and Trans Lifeline offers peer support and emergency grants. Many local LGBTQ+ centers also connect individuals with trans-friendly therapists who offer sliding-scale fees.
Advocacy & Community Action
- Join local and national groups: Get involved with organizations working to protect trans rights.
- Speak out when safe: Sharing stories through op-eds, social media, and public testimony can change public perception and influence policy.
- Vote and mobilize: Support candidates who oppose trans healthcare bans, sign petitions, and back ballot initiatives to overturn harmful laws.
- Educate allies: Misinformation fuels these bans—help friends and family understand that gender-affirming care is life-saving and evidence-based.
Staying Informed & Safe
If you or a loved one is affected by bans, plan ahead:
- Keep medical records secure.
- Be cautious about sharing transition details in hostile states.
- Use encrypted communication for sensitive conversations.
- Know which states have shield laws protecting patients and providers.
While the current climate is challenging, you have rights, and a vast community is fighting for you. Trans people have always existed, and no law can erase that reality. Stay informed, connected, and prepared—your health and safety matter.
The Bottom Line
The legal landscape for transgender healthcare is in flux, with severe crackdowns in Republican-led states and strong protections in Democratic-led ones. The Supreme Court’s upcoming ruling on Tennessee’s law could set a national precedent, determining whether these bans stand or fall.
For those living in restrictive states, relocation or traveling for care remains a difficult but sometimes necessary option. The fight for transgender healthcare is far from over, and advocacy at both the state and federal levels is crucial.
Stay informed, stay strong, and know that there are people fighting for you.
