Idaho considers a ban on using public funds or facilities for gender-affirming care

BOISE, Idaho (AP) — Idaho lawmakers are expected to vote this week on a bill that would ban the use of any public funds for gender-affirming care, including for state employees using work health insurance and for adults covered by Medicaid.

The legislation already passed the House and only needs to clear the majority Republican Senate before it is sent to Gov. Brad Little's desk, where it would likely be signed into law. The Republican governor has said repeatedly he does not believe public funds should be used for gender-affirming care.

If the legislation is enacted, 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 battle over the rights of LGBTQ+ Americans.

Opponents to the Idaho bill say it almost certainly will lead to a lawsuit in federal court. The state has already been sued multiple times over attempts to deny gender-affirming care to transgender residents and so far has not had much success defending the lawsuits.

In one case, the state was ordered to provide a transgender inmate with gender-transition surgery, and the inmate was later awarded roughly $2.5 million in legal fees.

Last year a federal judge barred Idaho from enforcing its newly enacted ban on gender-affirming medical care for minors until a lawsuit brought by transgender youth and their families is resolved. A different federal judge denied the state's motion to dismiss a separate lawsuit filed by adults in 2022 who said Medicaid officials wrongly denied coverage for their medically necessary gender-affirming treatment.

“This bill violates the 14th Amendment equal protections clause” and the federal Medicaid Act, Boise attorney Howard Belodoff told lawmakers during a hearing on Thursday.

Belodoff represents the transgender adults who sued the state over what they said were discriminatory Medicaid policies excluding coverage for genital reconstruction surgery.

“You cannot distinguish between providing care on the basis of diagnosis, type of illness or condition,” Belodoff said. “That's exactly what this bill does: it violates the Medicaid Act.”

One of the bill's sponsors, Republican Rep. Bruce Skaug, said those lawsuits prompted creation of the bill.

“This is a taxpayer protection bill in my view,” Skaug said, suggesting that without it the state could end up paying millions for gender-affirming care. Roughly 70% of Idaho's Medicaid program is federally funded.

Some who testified against the bill suggested it could have a far larger 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 Idaho Department of Correction employee, noted that many correctional employees work 12- to 16-hour shifts, which can require taking some prescribed medications like hormone therapy while on the job.

But the legislation bars the use of any state property, facility or building for providing surgical operations or medical interventions, which could mean employees would be subject to criminal penalties for taking their own legally prescribed medication while in a break room, Craghtten said.

The punishment for violating the law would include fines ranging from $300 to $10,000 and imprisonment between one and 14 years.

At least 23 states including Idaho have passed laws banning gender-affirming care for minors. Some states also have 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 examinations 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 the enforcement of gender-affirming care bans for minors in Idaho, Montana and Arkansas, they have allowed enforcement in Alabama and Georgia.