Missouri’s Supreme Court upheld the state’s ban on gender-affirming care for minors this week, along with a prohibition on Medicaid coverage of gender-affirming care for anyone in the state.
As the Missouri Independent reports, the court’s unanimous decision upholds a 2024 circuit court ruling in a case challenging Senate Bill 49. The law, signed by Gov. Mike Parson (R) in 2023, bans minors from accessing any form of gender-affirming care, including puberty blockers, hormone replacement therapy, and surgeries. It also bans the state’s Medicaid program from covering gender-affirming care for people of all ages.
The challenge against the law was brought by Lambda Legal and the ACLU of Missouri on behalf of three families of transgender young people, medical providers, and LGBTQ+ advocacy organizations, who argued that the law should be subject to heightened scrutiny, a more rigorous legal standard applied to cases involving the classification of individuals by specific characteristics like gender.
According to the Missouri Independent, the state Supreme Court rejected that argument, as had the lower court. While plaintiffs had argued that the law discriminates on the basis of sex and transgender status, Judge Kelly Broniec wrote in the court’s decision that S.B. 49 “classifies only based on medical use and age.”
The court’s reasoning echoes that in the U.S. Supreme Court’s ruling last year in United States v. Skrmetti, which held that Tennessee’s ban on gender-affirming care for trans youth does not discriminate on the basis of sex or transgender status.
As the Missouri Independent notes, Supreme Court precedent allows lawmakers broad discretion when it comes to issues “fraught with medical and scientific uncertainty.”
While for decades there has been broad scientific consensus — including among all major American medical associations — that gender-affirming care is safe, evidence-based, and often lifesaving for minors experiencing gender dysphoria, conservative organizations and some American media outlets have made massive strides in recent years in sowing doubt about that consensus.
In September, Lambda Legal attorney Nora Huppert argued that the lower court’s decision upholding S.B. 49 included “legal and factual errors.” But writing for the Missouri Supreme Court this week, Broniec nonetheless said that the state had “demonstrated the ongoing debate among medical and ethical experts regarding the risks and benefits associated with the treatments at issue.”
The court also rejected arguments that the Medicaid ban violates Missouri’s constitution, with Broniec noting that adults in the state can still pay out-of-pocket to receive gender-affirming care.
Gillian Wilcox, director of litigation at the ACLU of Missouri, responded to the decision saying that it “not only allows the state to target transgender Missourians access to health care but also leaves everyone’s health care options at the whims of politicians, should certain care ever fall into the political arena.”
Advocates for the LGBTQ+ community say the new limits on the food assistance program, SNAP, may make it especially difficult for many LGBTQ people battling food insecurity.
SCOTT DETROW, HOST:
2025 was a tumultuous year for the Supplemental Nutrition Assistance Program, or SNAP, between changes enacted as part of President Trump’s One Big Beautiful Bill Act and then the government shutdown that interrupted benefits. As Rebecca Smith with member station KBIA in Columbia, Missouri, reports, these changes are having a disproportionate effect on one already vulnerable group, LGBTQ people.
REBECCA SMITH, BYLINE: Emilia Stauffer walks towards the back of the GLO Center in Springfield, Missouri, carrying a heavy box of canned vegetables to a small closet that’s packed to the brim with boxes of shelf-stable foods, hygiene products and more.
EMILIA STAUFFER: So this is where everything gets stored.
SMITH: Stauffer is the community services specialist for the GLO Center, which supports the LGBTQ+ community throughout Southeast Missouri. In early 2025, the center recognized the rising need in their community for help accessing resources such as housing, health care and food.
STAUFFER: We have a population that is underemployed, underinsured, either not able or scared to access services.
SMITH: In a 2025 report, the Williams Institute at the UCLA School of Law, which studies LGBTQ+ law and policy, reported that 2.1 million LGBTQ+ adults were enrolled in SNAP nationwide. But now, following the passage of Trump’s One Big Beautiful Bill, which puts limits on the food assistance program, it could be harder for them to receive and retain benefits. Stauffer says for her clients, that’s not a new challenge. Many don’t seek out help due to fear of discrimination or the risk of violence.
STAUFFER: They’re literally terrified. I know we’re here to talk about food, but just even the idea of being flagged as trans is terrifying.
SMITH: People often have to present identification at food banks and pantries, which could inadvertently out transgender and gender-nonconforming people whose identities may not match the gender on their IDs. Plus many food pantries are tied to religious groups. One 2022 analysis, published in the BMC Public Health journal, found that more than 60% of U.S. food pantries were affiliated with faith-based groups.
STAUFFER: Not all faith organizations are the same, but when one has experienced religious trauma, it’s easier to overgeneralize than to make that risk.
SMITH: Because of this, Stauffer meets with groups in the area to determine if they would be safe and welcoming for her clients, but she says it can still be hard for people to go into spaces that historically have been unwelcoming. Brad Sears agrees. He’s one of the founders of the Williams Institute and studies food insecurity in the LGBTQ+ community. He says there’s many reasons beyond just fear of discrimination that LGBTQ+ people are food insecure and less likely to use SNAP than their straight or cisgender peers, such as higher rates of poverty and less of a support system.
BRAD SEARS: And, you know, the vast majority of people overall and in the LGBT community who rely on SNAP are either disabled, or they’re raising young children.
(CROSSTALK)
SMITH: Since March 2025, the GLO Center in Springfield has worked with at least 250 individuals and families. As Missouri implements SNAP changes, which reduces benefits for some and makes others ineligible altogether, the center has already seen a fourfold increase in need. Here’s executive director Aaron Kitchens.
AARON KITCHENS: The queer community is – we’re known for our resilience. And so we want to take action not just ’cause it’s the right thing to do, but also because these are our friends and family. Like, this is our community.
SMITH: Kitchens says the center will continue to find ways to provide direct care to the LGBTQ+ community in the region. All folks have to do is call or drop by. For NPR News, I’m Rebecca Smith in Springfield, Missouri.
Missouri State Sen. Joe Nicola (R) introduced a bill that would ban “social transition” in schools and forcibly out any transgender and nonbinary students to their potentially unsupportive parents if the students ask a school staff member to address them by a name or gender identity different from the sex assigned to them at birth.
The bill would also allow teachers to be fired and banned from teaching, as well as schools to be sued for affirming trans and nonbinary students’ gender identities, even if a parent approves of their child socially transitioning.
S.B. 1085, one of 21 anti-LGBTQ+ bills recently introduced by Missouri State Republicans, requires school staff members to inform the principal or a designee within 24 hours if any student asks them to “participate in or support” their social transition by having them address them by a name or gender identity that differs from those they were assigned at birth. The principal or designee would then have 72 hours to inform the student’s parents.
The bill would forbid school staffers and counselors from affirming a student’s trans or nonbinary gender identity or teaching about such identities. School districts would also be forced to fire teachers who violate the law and begin proceedings to revoke those teachers’ teaching licenses. Parents and the state attorney general may also pursue a civil lawsuit against any school or school district that violates the law.
The bill has no exception for parents who approve of their child’s social transition. This essentially forces educators to continue misgendering trans students and invalidating their identities even if they personally support trans and nonbinary students. Studies have shown that social transitioning improves the overall health and well-being of trans children.
Trans journalist Erin Reed wrote that the bill “underscores a shift in how anti-trans legislation is being sold to the public.”
“For years, supporters of bathroom bans, sports bans, and ‘don’t say gay’ policies framed their efforts as battles for ‘parental rights.’ Increasingly, though, that language has fallen away as lawmakers move to strip supportive parents of any authority at all, mirroring the approach in medical transition bans that override parental consent entirely.”
Nicola’s bill is just one of numerous anti-LGBTQ+ bills introduced in the state legislature. The other proposed bills would require the state to deny all legal recognition of non-cisgender identities; roll back nondiscrimination protections for transgender people; ban trans students from accessing school facilities or sports teams matching their gender identities; ban schools from displaying Pride flags; and allow anyone working with schools to misgender other employees’ trans/nonbinary gender identities.
The other proposed bills would also forbid state agencies from allowing gender changes on government-issued identity documents; ban trans people from using public facilities matching their gender identities; ban teachers from being a member of any sports organizations that allow trans participation; ban all “obscene” content from schools (including LGBTQ+ educational materials); forbid all gender-affirming care for minors; and designate all drag performances as “adult cabaret” performances (whose viewing by children can be criminally charged).
In April, Nicola voiced support for a state bill that would ban trans and nonbinary people from using “bathrooms, locker rooms, sports facilities, various crisis centers, prisons,” and other sex-segregated spaces that match their gender identity.
When a doctor testified against the bill, noting that such bans negatively affect trans people’s well-being, Nicola replied, “I’m not going to listen to doctors that say one thing that disagrees with a God of creation. You want to kind of berate me a little bit by saying we should listen to what doctors have to say, what your schooling has to say, over what the scripture has to say — it’s not happening with me.”
Nicola may not realize that the Bible has several scriptures that theologians interpret as being supportive of trans people and their identities.
Up to an estimated $879 million in LGBTQ+ household and business income has left Missouri in recent years, as queer residents flee a hostile political environment, according to a recent analysis by the Movement Advancement Project (MAP).
The state lawmakers responsible for creating this financial drain were warned, the Missouri Independent reports.
For years, business organizations, advocacy groups, and individuals cautioned officials pushing discriminatory laws that the economic fallout would be one deleterious result.
Local officials and chambers of commerce raised red flags about impacts on workforce recruitment, employee retention, and the ability to lure businesses to the state.
Now, economic data is confirming those predictions.
“When people feel unwelcome or uncertain about their future in a community, they often take their skills and their families elsewhere,” Tracey DeMarea, executive director of the Mid-America LGBT Chamber of Commerce, told The Independent. “That loss affects our workforce, our businesses, and our shared sense of community.”
A 2023 Wells Fargo report revealed that states with bigger LGBTQ+ populations have higher rates of economic growth, while the inverse is also true.
Multiple surveys and studies show that LGBTQ+ people — young adults in particular — have moved or are considering moving from states hostile to LGBTQ+ rights. An estimated 3% of cisgender young people and 5% of all trans people have already fled red states.
The economic impact of ideological legislation on the broader community is often lost on the lawmakers pushing it, according to Naomi Goldberg, MAP’s executive director.
“The responsibility of lawmakers is to represent communities across the state, and when they pass laws that target already vulnerable communities, they should consider their actions,” she said. “When families choose to leave the state, the loss is not only in the vitality and diversity of the community, but also in the economic power and resources that families provide.”
One example of the warnings came in 2024, during a marathon hearing on multiple bills, including proposed rules covering restrooms in private businesses. Lobbyists stayed up late explaining to lawmakers that the bills were a threat to “free enterprise” and “business development.”
“Businesses want to ensure that people feel comfortable and safe in their workplaces,” Kara Corches, president and CEO of the Missouri Chamber of Commerce and Industry, told committee members. “Their ability to recruit and retain talent is their top concern.”
Henry Eubank, governmental affairs coordinator for Greater St. Louis Inc., said that the discriminatory legislation before the committee depicted Missouri as unwelcoming.
“It sends a powerful negative signal to potential residents, investors, businesses, and workers,” he told lawmakers, “that the state of Missouri is not a place that they would want to visit, live, to do business, to start a business, or move their family.”
The last was the final straw for St. Louis restauranteur Rob Connoley, who is gay. He was a newly awarded James Beard finalist for his Ozark cuisine when he was in London representing Missouri at an international food festival not long ago.
“It felt egregious and awkward to be promoting a state in a region that was actively working against my own personal interests,” he told The Independent.
So Connoley packed up his kitchen and headed to Oregon.
“It made more sense for me to take my entrepreneurial skills and go to a community that I think would be more supportive of what I’m trying to accomplish,” he said.
Music superstar Chappell Roan has announced the launch of her organization devoted to supporting trans youth.
The Midwest Princess Project — a nod to her album, The Rise and Fall of a Midwest Princess — has already raised more than $400,000 through fundraising efforts at Roan’s recent pop-up shows.
“Those funds will be donated to incredible organizations making a positive impact for trans youth in their communities,” Roan wrote on social media when launching the project in late October.
The post named six organizations to which it has already donated: The Ali Forney Center and The Center in New York City, the GLO Center and The Center Project in Missouri, and the TransLatin@ Coalition and Trans Wellness Center in Los Angeles.
The TransLatin@ Coalition and The Ali Forney Center are some of the first beneficiaries. The project’s website says its goal is to “uplift trans youth and LGBTQ+ communities through action, care, and connection.”
The project’s launch is in keeping with Roan’s pledge to donate a portion of ticket sales from her tour to trans organizations. During a red-carpet interview at the Grammy Awards in early February, Roan acknowledged the state of transgender rights in the U.S. in just the first month of the current presidential administration.
“It’s brutal right now,” Roan said, “but trans people have always existed, and they will forever exist, and they will never, no matter what happens, take trans joy away, and that has to be protected more than anything.”
“I would not be here without trans girls,” she added. “So, just know that pop music is thinking about you and cares about you. And I’m trying my best to stand up for you in every way that I can.”
During a live show in October, she also opened up about how she struggles with fame but that it’s all worth it to be able to spread queer joy.
She said she has questioned why she continues in her career when it makes her feel so “left out in public” and “so awkward all the time,” but that the tour helped her realize exactly why she keeps going.
“I always felt, actually, ‘Why am I putting myself through this? If this is taking so much away from me, what is this for?’ Then I started doing shows again and it all made sense, it was to literally bring queer people joy,” she said.
“There [are] so many things in the world that are so ‘F**k you’,” she continued, “and then there is this. It’s the only thing that matters is joy anymore to me, and protecting that, and peace and safety. So, I hope you know that when you are here, you are safe, and I want you here. You can be whoever you are tonight. You’re cherished for everything that you are.”
She said protecting that joy is one of the most important things, and “even if you’re not queer, I hope you know that I include you.”
Karma Yoakum had been part of a community of political activists in Texas for years. However, as the relentless tide of anti-trans legislation kept rising, it became clear that it was time for them to relocate, recover their energies, and take on a different role in the larger fight.
Finding a new home in the Pacific Northwest, Karma was able to do just that. But the road wasn’t without its challenges, and finding their new community required intention and perseverance once they had recovered a little bit of who they were by living in a state that wasn’t trying to persecute them for their existence.
As anti-trans sentiment and legislation have been on the rise across the United States in recent years, many trans and nonbinary people have made the difficult decision to flee red states. In moving to a bluer state, trans people are making a choice based on safety, but that doesn’t make it an easy choice. It means leaving behind a home and community you have built over years or your whole life because of the machinations of people who hate you. While a new state can fix a lot of problems, building a new community doesn’t happen overnight. The president’s re-election and the introduction of federal anti-trans bills have created a flashpoint for even more trans people to seek safer pastures in states that might protect them.
I wanted to understand the challenges and opportunities that trans people face when starting over and building a new community in a blue state. I spoke with four trans and nonbinary people who have relocated in the last six to twelve months. They shared the challenges, the successes, and advice for others who are considering relocating to a sanctuary state.
Why trans people are leaving their red state communities
Major relocations often happen around an institution, such as going to college or starting a new job. But moves like those come with some built-in community-building support.
Relocating as a refugee from a red state can be a more lonely affair. Most of the people I spoke with found that building a new community felt like work exacerbated by not having the same connections and support systems they had in the communities they left behind.
Clark Roman had been well-established in St. Louis. Both Clark and his boyfriend had owned their own houses and had a strong community of friends and chosen family in the city. But he says he saw the writing on the wall in 2023 when the Missouri attorney general enacted a de facto ban on trans hormones and trans healthcare that included adults. While his emergency rule was blocked by a judge and then withdrawn, the legislature went on to pass a gender-affirming care ban for trans youth. It was clear where things were headed, and Clark moved to Minneapolis a few months later.
Leaving behind a large community, both queer-centric and otherwise, Clark has found it hard to make more connections in his new city. At the center of it is the challenge of the modern age: balancing work and social life. “The honest truth is I have a very, very stressful job and I have not had the space in my life to build community the way I want.” He noted that it felt like he had to “treat building a new community as a second job.”
Karma also struggled to make connections when they first relocated from Texas to Washington state. After living in Texas for years, they reached a point where they found themselves saying, “I’m feeling scared and trapped and there’s absolutely nothing keeping me in Texas anymore.”
Karma moved 2,000 miles to Seattle but found a problem when they arrived. While their new home was more welcoming to the gender diverse, there was still culture shock to get over. “Where is everybody? I heard it was this wonderful panacea, a place where I would be welcomed. So, I looked around and I learned what the Seattle chill was. And it’s not a horrible thing, it’s just a difference in culture, because I’m used to southern culture.”
Chris (his name has been changed to protect his privacy) echoed Karma’s frustrations over Washington state’s laid-back attitude to building community. Like Clark, Chris was living in St. Louis, saw the anti-trans legislation in Missouri in 2023, and concluded that “living in Missouri as a trans human, [he] was at risk.” He made the move to Washington state in 2024 while watching the coming election without much hope.
While St. Louis had its flaws, Chris was leaving behind a lot of queer community and resources. He had worked with the St. Louis Metro Trans Umbrella Group for nearly 20 years, enjoyed events and meetups, and collected queer friends through meets at clubs, bars, and drag shows. But the same culture shock that Karma experienced has made it hard to build new connections: “It’s been honestly a huge struggle, much more than I anticipated.”
While it’s important to know that people are struggling with finding new communities in their new states, it’s not all doom and gloom. Clark and Chris have both been able to stay in touch with parts of their communities from before their moves through travel and online communication. While that’s not always the same, it’s a nice option to have. I also spoke with Mira Lazine – an LGBTQ Nation contributor – who relocated from Cincinnati to Minneapolis and had a different sort of experience.
While the Ohio governor vetoed HB 68, which banned gender-affirming care for minors, he then introduced care guidelines for the state. “These rules were basically going to amount to a total care ban for all adults in Ohio,” explained Mira. “And it even would include some aspects of conversion therapy and mental health treatment.”
It was time to relocate, and someone recommended Minneapolis. For Mira, finding a new community in this queer-friendly space came a lot easier.
“Within the first week of moving here, I went to a few coffee shops, and everyone, like the baristas, were trans, and they were recommending me support groups to join, discord servers I can join, like the whole nine yards. And it’s just been way easier to meet people and meet other queer people and form connections here.”
While Karma and Chris suffered from culture shock, Mira found herself among other transplants to the state who had their relocation in common: “Probably like 80% of the queer people I’ve met aren’t originally from Minnesota, so we’re all like, yeah, we need community, let’s build one.”
Finding new communities in blue states
All of the people that I spoke with had been in their new homes for less than a year. While there have been struggles, they have been able to find resources and spaces to start that community-building process and are in different places in their journeys.
Clark noted that his struggle to find community in Minneapolis is probably the biggest dissatisfaction in his life right now. But he can see a light at the end of the tunnel through some of the community spaces that he is attending. “The synagogue I go to is very open and trans-friendly. So that was helpful.” Clark is also looking at getting more involved with Transplants, a group for LGBTQ+ people who have relocated to Minneapolis and St. Paul.
Chris has found that his work at a university in Washington provides some space for community building. “Their DEI office held a holiday event for, I guess, everyone, but the folks who showed up to that event were primarily queer folks and persons of color. And that was fantastic.”
Chris still faces challenges, even at the events. He told me that he has been going to meet-up groups, Portland Pride, the Ingersoll Gender Center, and more, but he wasn’t satisfied with the results. Chris suggested that part of that problem might be visibility: “I am stealth, so at my workplace, I’m not fully out [as trans]. Where I landed is sort of a purple city in a blue state. I’m typically able to pass as male and not be questioned at all, which is, is nice, but at the same time, it’s hard because I think visibility might help me connect with more queer people.”
For Karma, their initial struggles with community-building in Seattle began to bear fruit around the one-year mark. “I did the things that I’ve tried before, and I figured, if they’ve worked everywhere else, they ought to work here. Maybe it just takes a little longer. And yeah, that was it. It takes a little longer.”
Karma found that organizations were the key. They found like-minded people when they returned to playing music with the local band that is part of the LGBTQ+ band organization, Pride Bands Alliance, an international group that Karma has worked with since the 1990s. Similarly, local chapters of a national support network have provided success in community building: “PFLAG, all you have to do is show up to a meeting. There are people there that if you need a hug, they are instant family. And people that aren’t instant family are there because they want support.”
Karma also reached into her past in political activism and found that, post-move, they had the energy to continue in their new home. “The third place that I decided to get involved was the Gender Justice League. Dealing with legislation, dealing with victims of violence here in the Seattle area. So, supporting our community, advocating like crazy.” After months of struggling to find their people, Karma now finds that barely a day on their calendar doesn’t include a community event, a catch-up, or a coffee meet.
No regrets
Everyone’s experience with relocating to a bluer state will be unique. However, there was one ringing agreement amongst all the people that I spoke with: no regrets. When asked what advice they had for someone considering a move, Clark, Chris, Mira, and Karma all urged people to relocate if they felt it might help.
Clark grieves what he left behind but recognizes that it was the right call for him, and he’s going to keep trying to find his new community. “I think it’s dissatisfying at first. But it’s important to [show] up repeatedly because I think that repeated showing up [is] how I made my community originally in St. Louis.”
Chris echoed those sentiments, noting that he has no regrets and that it has been “completely worth it.” Watching recent election results come in wouldn’t have been fun anywhere, but he was glad to be in a safe space for it all “despite challenges and some loneliness.”
Karma isn’t even considering going back. “I would say do it. The relief that I felt by at least being in a community where I know that I’d no longer have to deal with local politics.”
“In Texas, the local politics were against me,” they said. “At least here, I know locally and statewide, my representatives really do represent everybody, and they have my back. And that has made so much a difference in my life.”
The nine-day trial featured witnesses with varying levels of credibility.
A Missouri county judge has upheld the state’s ban on gender-affirming care for minors.
In a 74-page ruling issued on Monday, Wright County Circuit Court Judge Craig Carter stated, “If we don’t let a 16-year-old buy a six-pack of beer and a pack of cigarettes, or allow an adult to purchase them for the teen, should we permit the same child and parent to decide to permanently alter the teenager’s sex?”
The restrictions on gender-affirming care, passed by Missouri lawmakers in 2023, prohibit minors from using hormones, puberty blockers, and undergoing gender-affirming surgeries. The law also blocks state funding for gender-affirming care for adults through Medicaid and for incarcerated individuals in state prisons.
The ACLU of Missouri and Lambda Legal have promised to appeal the ruling.
Judge Craig Carter acknowledged the “ethical minefield” of the case, writing that “the medical profession stands in the middle” with “scant evidence to lead it out.”
The nine-day trial featured witnesses of varying credibility, with the state’s Solicitor General Joshua Divine introducing partisan politics into the proceedings. Some experts presented research that had been retracted, which the plaintiffs argued was problematic. Divine maintained that the scientific community had dismissed the research due to “cancel culture.”
Carter’s ruling was partly based on testimony from Jamie Reed, a whistleblower who previously worked at the Washington University Transgender Center at St. Louis Children’s Hospital. Reed’s affidavit helped inspire the gender-affirming care ban. She testified that the hospital treated many patients with mental health issues without comprehensive psychological evaluations. There was disagreement at trial over whether a licensed therapist’s evaluation was sufficient for gender-affirming care, or if a psychologist or psychiatrist was required.
The judge found Reed’s testimony credible, noting, “Her testimony does not arise from any ideological or other bias.” He also pointed out that Reed is married to a transgender individual.
Reed is now the executive director of the LGBT Courage Coalition, an advocacy group that opposes gender-affirming care for minors. The day before she testified, her partner announced he was discontinuing testosterone treatments and “detransitioning.”
While Carter accepted Reed’s credibility, he was less convinced by some of the plaintiffs’ witnesses. He expressed concerns about deferring to organizations like WPATH, which the plaintiffs relied on. WPATH, the World Professional Association for Transgender Health, is a professional group that sets standards for gender-affirming care, but Carter noted that it self-describes as being “committed to advocacy.”
Ultimately, Carter’s ruling emphasized U.S. Supreme Court precedent that grants lawmakers broad discretion in areas “fraught with medical and scientific uncertainty.” He concluded that there is “an almost total lack of consensus as to the medical ethics of adolescent gender dysphoria treatment,” and therefore, the state legislature has the authority to ban the care.
Florida first. Alabama follows. Legislators in Louisiana and Ohio are currently debating legislation that is similar to the Florida statute. A similar bill will be his top priority during the following session, according to Texas Governor Greg Abbott.
At least a dozen states across the country are proposing new legislation that, in some ways, will resemble Florida’s recent contentious bill, which some opponents have dubbed “Don’t Say Gay.”
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