2025–2026
Many states banned or limited sex-rejecting procedures for minors, the Supreme Court said those state bans may stand, and a federal Medicaid rule cuts funding for those procedures on minors.
Federal actions
United States v. Skrmetti (18 June 2025)
The Supreme Court upheld Tennessee’s SB 1 against an Equal Protection challenge. State bans may stand.
Official sources
HHS evidence review (November 2025)
HHS published a peer-reviewed evidence review on treatment for pediatric gender dysphoria.
Official sources
CMS Medicaid / CHIP funding rule — FINAL
CMS-2451-F ends federal Medicaid funding under 18 and CHIP funding under 19 for sex-rejecting procedures, effective 13 October 2026. A 22-state and D.C. suit is pending; the rule has not been blocked.
Official sources
Department of Justice hospital resolutions
DOJ has announced resolutions involving Texas Children’s, Cleveland Clinic, Connecticut Children’s, and Mount Sinai over pediatric sex-rejecting procedures. Those are allegations and settlements, not findings of guilt and not a state statute. DOJ states the claims resolved are allegations only.
States and D.C.
- Medical · Ban · 22
- Medical · Restriction · 4
- Medical · Litigation-setback · 2
- Medical · Proposed bill · 3
- Medical · No ban · 20
- Schools restriction · 3
click a state for more details.
- BanStatute in force.
- RestrictionNarrower than a total ban.
- Litigation-setbackBan or limit was enacted, then a court blocked it. The statute is on the books; it is not enforced.
- Proposed billA bill has been introduced. It is not a statewide law yet.
- No banNo statewide medical ban. Shield laws, if any, are in the state summary.
Alabama AL
Alabama banned puberty blockers and hormones for minors, and that ban is in force.
Official sources
Vulnerable Child Compassion and Protection Act. The 11th Circuit let the puberty-blocker and hormone prohibitions take effect. The Supreme Court dismissed the later petition, and the district case was dismissed. The ban is in force.
Alaska AK
No state law restricts puberty blockers, cross-sex hormones or surgery for minors.
Official sources
No state law restricts puberty blockers, cross-sex hormones or surgery for minors.
Arizona AZ
Arizona banned irreversible gender-reassignment surgery on minors. As of 13 October 2026, AHCCCS no longer covers puberty blockers or testosterone products used for gender dysphoria under 19, with a six-month grandfather for patients who started them on or before that date.
Official sources
SB 1138 (2022) prohibits irreversible gender-reassignment surgery on minors. As of 13 October 2026, AHCCCS fee-for-service pharmacy prior-authorization criteria no longer cover puberty blockers or cross-sex hormones used for gender dysphoria in patients under 19. The criteria name gonadotropin-releasing hormone agonists and testosterone products, and deny those requests as a benefit exclusion. Patients who started them on or before 13 October 2026 are grandfathered for six months.
Arkansas AR
Arkansas banned sex-rejecting procedures for minors, and that ban is in force.
Official sources
Act 626 prohibits gender-transition procedures on minors. The 8th Circuit reversed the permanent injunction on 12 August 2025 (Brandt, No. 23-2681). That is a revival of the statute, not a new law.
California CA
No statewide ban. A shield law treats sex-rejecting procedures as California public policy. After 13 October 2026, California is continuing puberty blockers, cross-sex hormones, and surgery for minors with state funds through an HCAI grant that is not yet available. Members already on cross-sex hormones may stay on Medi-Cal payment through 12 April 2027.
Official sources
No statewide ban. A Civil Code shield (Title 1.81.7) treats sex-rejecting procedures — puberty blockers, hormones, and surgeries provided under California law — as public policy. It limits other states from using California courts, agencies, or records to punish patients, parents, or clinicians for that care. After 13 October 2026, California is continuing puberty blockers, cross-sex hormones, and surgery for minors with state funds through an HCAI grant that is not yet available. Members already on cross-sex hormones may stay on Medi-Cal payment through 12 April 2027.
Colorado CO
The Colorado Supreme Court ordered Children’s Hospital Colorado to resume puberty blockers and cross-sex hormones for minors pending trial. Colorado suspended Medicaid and CHP+ payment for those procedures on 13 October 2026 until lawmakers act.
Official sources
In Boe v. Children's Hospital Colorado, 2026 CO 32 (18 May 2026), the Colorado Supreme Court ordered a preliminary injunction requiring the hospital to resume puberty blockers and cross-sex hormones for minors pending trial. SB23-188 is a shield: state law limits cooperation with out-of-state legal actions over these procedures when they are lawful in the state. Colorado suspended Medicaid and CHP+ payment for puberty blockers, cross-sex hormones, and related procedures on 13 October 2026 until lawmakers act.
Connecticut CT
No statewide ban. A shield law covers sex-rejecting procedures permitted under Connecticut law.
Official sources
No statewide ban. Conn. Gen. Stat. § 52-571n is a shield: a person may recover damages when an out-of-state judgment is based on reproductive or sex-rejecting procedures that are permitted under Connecticut law.
Delaware DE
No state law restricts puberty blockers, cross-sex hormones or surgery for minors. A spokesperson for Gov. Matt Meyer said Delaware will replace the lost federal Medicaid and CHIP funding in full.
Official sources
No state law restricts puberty blockers, cross-sex hormones or surgery for minors. A spokesperson for Gov. Matt Meyer said Delaware will replace the lost federal Medicaid and CHIP funding in full.
District of Columbia DC
No state law restricts puberty blockers, cross-sex hormones, or surgery for minors. D.C. Code § 2-1461.01 is a shield law.
Official sources
No state law restricts puberty blockers, cross-sex hormones or surgery for minors. D.C. Code § 2-1461.01 is a shield: state law limits cooperation with out-of-state legal actions over these procedures when they are lawful in the state.
Florida FL
Florida banned sex-reassignment prescriptions and procedures for minors.
Official sources
SB 254 (2023) / Fla. Stat. § 456.52 prohibits sex-reassignment prescriptions and procedures for minors, with a grandfather for treatment already underway. An 11th Circuit stay keeps the statute in force.
Georgia GA
Georgia banned hormones and surgeries for minors, but not puberty blockers.
Official sources
SB 140 (2023) prohibits certain cross-sex hormones and surgeries for minors for the purpose of gender transition. Puberty blockers are not expressly listed in the same terms.
Hawaii HI
No state law restricts puberty blockers, cross-sex hormones, or surgery for minors. Act 059 (HB 1875, 2026) is a shield law.
Official sources
No state law restricts puberty blockers, cross-sex hormones or surgery for minors. Act 059 (HB 1875, 2026), effective 1 July 2026, is a shield: state law limits cooperation with out-of-state legal actions over these procedures when they are lawful in the state.
Idaho ID
Idaho banned sex-rejecting procedures for minors, and that ban is in force.
Official sources
HB 71 (2023), now Idaho Code § 18-1506C, prohibits puberty blockers and other listed gender-transition procedures on minors. Poe v. Labrador was dismissed in 2025. The ban is in force.
Illinois IL
No state law restricts puberty blockers, cross-sex hormones, or surgery for minors. SB 3920 is dead. Public Act 102-1117 is a shield law. Illinois is paying for puberty blockers, cross-sex hormones, and surgery for minors with state funds through 30 June 2027.
Official sources
No state law restricts puberty blockers, cross-sex hormones or surgery for minors. SB 3920 is dead. Public Act 102-1117 is a shield: state law limits cooperation with out-of-state legal actions over these procedures when they are lawful in the state. Illinois is paying for puberty blockers, cross-sex hormones, and surgery for minors with state funds through 30 June 2027.
Indiana IN
Indiana banned sex-rejecting procedures for minors, and that ban is in force.
Official sources
SEA 480 (2023) prohibits gender-transition procedures for minors, including puberty blockers, with stated exceptions. The 7th Circuit vacated the preliminary injunction. The ban is in force.
Iowa IA
Iowa banned sex-rejecting procedures for minors, and that ban is in force.
Official sources
SF 538 (2023) prohibits gender-transition procedures and certain prescriptions for minors.
Kansas KS
Kansas passed a ban, but a court blocked the puberty-blocker and hormone parts, so access is restored for now.
Official sources
SB 63 (Help Not Harm Act, 2025) is an enacted statute. A Douglas County District Court temporary injunction on 15 May 2026 blocked enforcement of the puberty-blocker and hormone sections (now K.S.A. 65-28,139(a)(2), (a)(3), (b)(2), and (b)(3)). The Attorney General noticed an appeal. A court blocked enforcement of the puberty-blocker and hormone sections.
Kentucky KY
Kentucky banned sex-rejecting services for minors, and that ban is in force.
Official sources
KRS 311.372 prohibits drugs that delay or stop normal puberty, plus hormones and listed surgeries for minors.
Louisiana LA
Louisiana banned certain sex-rejecting procedures for minors, and that ban is in force.
Official sources
HB 648 (2023) prohibits certain gender-transition procedures for minors.
Maine ME
No statewide ban. A shield law remains. Maine is paying Medicaid and CHIP claims for puberty blockers, cross-sex hormones, and surgery for minors with state funds.
Official sources
No statewide ban. 14 M.R.S. § 9002 is a shield: “legally protected health-care activity” includes sex-rejecting procedures authorized under Maine law, so other states have a harder time using Maine process against that care. Maine is paying Medicaid and CHIP claims for puberty blockers, cross-sex hormones, and surgery for minors with state funds.
Maryland MD
No state law restricts puberty blockers, cross-sex hormones or surgery for minors. Maryland is continuing puberty blockers, cross-sex hormones, and surgery for minors on Medicaid with state funds.
Official sources
No state law restricts puberty blockers, cross-sex hormones or surgery for minors. Maryland is continuing puberty blockers, cross-sex hormones, and surgery for minors on Medicaid with state funds.
Massachusetts MA
No state law restricts puberty blockers, cross-sex hormones, or surgery for minors. Acts of 2022, Chapter 127 is a shield law. Massachusetts is paying for puberty blockers and cross-sex hormones for youth from an $8.5 million state trust. About 550 MassHealth members 18 and under received them in the prior year.
Official sources
No state law restricts puberty blockers, cross-sex hormones or surgery for minors. Acts of 2022, Chapter 127 is a shield: state law limits cooperation with out-of-state legal actions over these procedures when they are lawful in the state. Massachusetts is paying for puberty blockers and cross-sex hormones for youth from an $8.5 million state trust. About 550 MassHealth members 18 and under received them in the prior year.
Michigan MI
HB 4467 would ban puberty blockers, cross-sex hormones, and listed surgeries for minors. It is not law yet.
Official sources
HB 4467 (2025–2026) would ban puberty blockers, cross-sex hormones, and listed surgeries for minors. The House passed it; the Senate referred it to Government Operations on 10 June 2026. It is not law yet.
Minnesota MN
No statewide ban. A shield law remains.
Official sources
No statewide ban. Minn. Stat. § 543.23 is a shield: Minnesota courts generally will not honor out-of-state subpoenas aimed at sex-rejecting procedures that are lawful in Minnesota.
Mississippi MS
Mississippi banned sex-rejecting procedures for minors, and that ban is in force.
Official sources
HB 1125 (2023) prohibits gender-transition procedures for minors.
Missouri MO
Missouri banned sex-rejecting interventions for minors, and that ban is in force.
Official sources
SB 49 / Mo. Rev. Stat. § 191.1720 prohibits gender-transition surgery and, until 28 August 2027, puberty blockers and cross-sex hormones for minors. The Missouri Supreme Court upheld it on 13 January 2026.
Montana MT
Montana passed a ban, but courts blocked it, so access is restored for now. Montana ended Medicaid coverage of puberty blockers, cross-sex hormones, and surgery for minors on 13 October 2026, with a taper for children already on cross-sex hormones.
Official sources
SB 99 (2023) is an enacted statute, later codified at MCA 50-4-1001 and following, covering puberty blockers and other listed interventions. In Cross v. State, 2024 MT 303, the Montana Supreme Court affirmed a preliminary injunction. The Missoula district court permanently enjoined enforcement on 13 May 2025. The statute exists; a court blocked enforcement. Montana ended Medicaid coverage of puberty blockers, cross-sex hormones, and surgery for minors on 13 October 2026, with a taper for children already on cross-sex hormones.
Nebraska NE
Nebraska bans gender surgeries under 19. New puberty blockers and hormones require a pattern that began or worsened at puberty, at least 40 hours of gender-identity therapy, informed consent, and a 7-day wait; courses started before Oct 1, 2023 may continue.
Official sources
LB 574 (2023), the Let Them Grow Act (Neb. Rev. Stat. § 71-7304), provides that a health care practitioner shall not perform gender-altering procedures on anyone younger than 19 except as the Act allows. Surgeries under 19 are not excepted. Continuation of puberty blockers and/or cross-sex hormones is allowed if the course began before October 1, 2023. New puberty blockers and cross-sex hormones are allowed only as nonsurgical procedures under § 71-7305 and DHHS 181 NAC 8 (adopted 17 March 2024): a long-lasting and intense pattern of gender nonconformity or gender dysphoria that began or worsened at the start of puberty; at least 40 gender-identity-focused therapeutic contact hours before prescribing; signed informed consent (and patient assent for unemancipated minors); and a minimum seven calendar day waiting period after informed consent before prescribing, administering, or delivering the drugs.
Nevada NV
No state law restricts puberty blockers, cross-sex hormones or surgery for minors.
Official sources
No state law restricts puberty blockers, cross-sex hormones or surgery for minors.
New Hampshire NH
New Hampshire banned puberty blockers and cross-sex hormones for minors from 1 January 2026. HB 619 (2024) covers surgery.
Official sources
HB 377 (Chapter 275, 2025) prohibits puberty blockers and cross-sex hormones for minors from 1 January 2026, with continuation for treatment begun earlier; HB 619 (2024) covers surgery.
New Jersey NJ
A1847 would prohibit sex-rejecting medical services for people under 21. It is not law yet. Executive Order 326 (2023) is a shield for procedures lawful in New Jersey.
Official sources
A1847 (222nd Legislature, 2026–2027) would prohibit sex-rejecting medical services for people under 21. It is not law yet. Enacted P.L. 2022, c. 51 remains a reproductive-health shield only. Executive Order 326 (2023) limits cooperation with out-of-state legal actions over these procedures when they are lawful in the state.
New Mexico NM
No state law restricts puberty blockers, cross-sex hormones, or surgery for minors. HB 7 (2023) is a shield law. New Mexico is paying with state funds for puberty blockers and cross-sex hormones for ages 12 to 17. That payment does not include surgery.
Official sources
No state law restricts puberty blockers, cross-sex hormones or surgery for minors. HB 7 (2023) is a shield: state law limits cooperation with out-of-state legal actions over these procedures when they are lawful in the state. New Mexico is paying with state funds for puberty blockers and cross-sex hormones for ages 12 to 17. That payment does not include surgery.
New York NY
No statewide ban. A shield law limits out-of-state subpoenas. After 13 October 2026, New York is paying for puberty blockers, cross-sex hormones, and related surgeries for minors on Medicaid and Child Health Plus with state funds.
Official sources
No statewide ban. CPLR § 3119 is a shield: New York limits out-of-state subpoenas aimed at legally protected health activity, including sex-rejecting procedures performed in New York. After 13 October 2026, New York is paying for puberty blockers, cross-sex hormones, and related surgeries for minors on Medicaid and Child Health Plus with state funds.
North Carolina NC
North Carolina banned certain sex-rejecting procedures for minors, and that ban is in force.
Official sources
HB 808 (2023) prohibits certain gender-transition procedures for minors.
North Dakota ND
North Dakota banned sex-reassignment procedures for minors, and that ban is in force.
Official sources
HB 1254 (2023) / N.D.C.C. 12.1-36.1-02 prohibits puberty blockers and listed hormones and surgeries for gender-transition purposes on minors. The North Dakota Supreme Court upheld it on 17 September 2026.
Ohio OH
Ohio banned puberty blockers and cross-sex hormones for minors. The ban stays in force while an Ohio Supreme Court decision is pending.
Official sources
HB 68 / R.C. 3129.02 prohibits puberty blockers and cross-sex hormones for minors. The Ohio Supreme Court stayed a lower-court injunction in April 2025 and heard argument on 24 March 2026; a decision is pending.
Oklahoma OK
Oklahoma banned sex-rejecting procedures for minors, and that ban is in force.
Official sources
SB 613 (2023) prohibits gender-transition procedures for minors.
Oregon OR
No statewide ban. A shield law remains. Oregon is paying with state funds for about 600 Oregon Health Plan members under 18.
Official sources
No statewide ban. Oregon Laws 2026, chapter 52 (HB 4088) is a shield: Oregon’s policy is to protect lawful sex-rejecting procedures provided in Oregon and to limit certain interstate cooperation against that care. ORS 24.500 already treats contrary out-of-state actions as against Oregon public policy. Oregon is paying with state funds for about 600 Oregon Health Plan members under 18.
Pennsylvania PA
HB 1033 would ban puberty blockers, cross-sex hormones, and surgeries for minors. It is not law yet. A spokesperson for Gov. Josh Shapiro said Pennsylvania will use state dollars to keep covering puberty blockers and cross-sex hormones for Medicaid-enrolled minors, and that state law bars state money for CHIP.
Official sources
HB 1033 (2025–2026) would ban puberty blockers, cross-sex hormones, and surgeries for minors. It was referred to House Health on 24 March 2025. It is not law yet. A spokesperson for Gov. Josh Shapiro said Pennsylvania will use state dollars to keep covering puberty blockers and cross-sex hormones for Medicaid-enrolled minors, and that state law bars state money for CHIP.
Rhode Island RI
No state law restricts puberty blockers, cross-sex hormones, or surgery for minors. H 8094 (2024) is a shield law.
Official sources
No state law restricts puberty blockers, cross-sex hormones or surgery for minors. H 8094 (2024) is a shield: state law limits cooperation with out-of-state legal actions over these procedures when they are lawful in the state.
South Carolina SC
South Carolina banned sex-rejecting procedures for minors, and that ban is in force.
Official sources
H. 4624 (2024) prohibits gender-transition procedures for minors.
South Dakota SD
South Dakota banned certain treatments meant to alter a minor’s sex characteristics, and that ban is in force.
Official sources
HB 1080 (2023) prohibits certain medical treatments intended to alter a minor’s sex characteristics.
Tennessee TN
Tennessee banned medical gender transition for minors, and that ban is in force.
Official sources
SB 1 / Tenn. Code Ann. title 68, ch. 33. Upheld against an Equal Protection challenge in United States v. Skrmetti (2025).
Texas TX
Texas banned puberty blockers, cross-sex hormones, and surgery for minors. The Texas Supreme Court upheld that ban on 28 June 2024.
Official sources
SB 14 (2023) prohibits puberty blockers, cross-sex hormones and surgery for minors; the Texas Supreme Court upheld it in State v. Loe (28 June 2024).
Utah UT
Utah prohibits new puberty blockers, cross-sex hormones, and surgery for minors. HB 174 (2026) makes that prohibition permanent and limits continuation for existing patients.
Official sources
SB 16 (2023) prohibits new puberty blockers, cross-sex hormones and surgery for minors. HB 174 (2026) replaces the moratorium with a permanent prohibition and limits continuation to certain existing patients.
Vermont VT
No state law restricts puberty blockers, cross-sex hormones, or surgery for minors. Act 15 (S.37, 2023) is a shield law. Vermont is replacing federal Medicaid funds with state funds and says nothing is changing for members.
Official sources
No state law restricts puberty blockers, cross-sex hormones or surgery for minors. Act 15 (S.37, 2023) is a shield: state law limits cooperation with out-of-state legal actions over these procedures when they are lawful in the state. Vermont is replacing federal Medicaid funds with state funds and says nothing is changing for members.
Virginia VA
No state law restricts puberty blockers, cross-sex hormones, or surgery for minors. As of 13 October 2026, Virginia Medicaid (under 18) and CHIP (under 19) no longer pay for puberty blockers, cross-sex hormones, or gender-transition surgeries. Youth already on cross-sex hormones may taper for up to six months; puberty blockers and surgeries have no taper.
Official sources
No state law restricts puberty blockers, cross-sex hormones or surgery for minors. As of 13 October 2026, Virginia Medicaid no longer pays for puberty blockers, cross-sex hormones, or gender-transition surgeries for members under 18, and CHIP no longer pays for them for members under 19. Youth already on cross-sex hormones as of that date may receive a federally funded taper of up to six months. Puberty blockers and surgeries have no taper. Mental health counseling stays covered.
Washington WA
No statewide ban. A shield law protects lawful sex-rejecting procedures in Washington. Washington is continuing puberty blockers, cross-sex hormones, and surgery for minors with state funds.
Official sources
No statewide ban. Chapter 7.115 RCW is a shield: Washington public policy is to protect lawful sex-rejecting procedures — including care that would be illegal in another state — and to limit out-of-state court process aimed at patients, parents, or clinicians for that care. Washington is continuing puberty blockers, cross-sex hormones, and surgery for minors with state funds.
West Virginia WV
West Virginia banned sex-reassignment surgery and sex-altering medication for minors, and that ban is in force.
Official sources
HB 2007 / W. Va. Code § 30-3-20 prohibits gender-reassignment surgery and gender-altering medication for minors, including puberty blockers. 2025 amendments removed the former severe-dysphoria pathway. The ban is in force.
Wisconsin WI
No state law restricts puberty blockers, cross-sex hormones or surgery for minors.
Official sources
No state law restricts puberty blockers, cross-sex hormones or surgery for minors.
Wyoming WY
Wyoming banned specified surgeries, puberty blockers, and certain hormones for children, and that ban is in force.
Official sources
SF0099 (2024), enrolled as SEA 52 / Chapter 113 and codified at W.S. 35-4-1001, prohibits specified surgeries, puberty blockers, and certain hormone doses for children, with a congenital / DSD and central-precocious-puberty exception. Main prohibitions took effect 1 July 2024.
Territories
U.S. territories are not the 50-state-and-D.C. grid and are not on the choropleth. Puerto Rico is listed here as a territory, not a 50th state.
Puerto Rico
BannedPuerto Rico banned sex-rejecting drugs and surgeries for people under 21.
Official sources
U.S. territory — not a 50th state. Ley 63-2025 bans sex-rejecting drugs and surgeries under 21.
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