States’ Obligation to Provide for Trans Youth: How Medicaid Requires (Most) States to Provide Access to Puberty Blockers
By GRACE WORCESTER. Full Text.
Over the last few years, many states have endeavored to strip minor access to gender-affirming healthcare, and these efforts have seen considerable success. By the end of 2023, twenty-two states had enacted legislation that limits youth access to gender- affirming healthcare. In line with these efforts, many states have created policies that exclude Medicaid coverage for gender-affirming puberty blockers—medications that delay the physical changes to one’s body that occur with sexual maturity. These efforts contravene guidance from the medical community, which pronounces the importance of access to gender-affirming puberty blockers for transgender and gender-diverse youth, and often considers them medically necessary for those experiencing gender dysphoria.
With such strong support from the medical community, state actions that limit minor access to gender-affirming puberty blockers call into question state compliance with the obligations imposed by the Medicaid Act. More specifically, the required expansive youth benefit—the Early and Periodic Screening, Diagnostic, and Treatment program—requires the provision of comprehensive preventative, diagnostic, and treatment services to identify and treat health issues in children.
This Note focuses on whether states can deny Medicaid coverage for gender-affirming puberty blockers under the Medicaid Act—an issue that has gone largely unexplored in the courts. In considering the research relating to gender dysphoria and puberty blockers, and after applying those findings to the requirements of the EPSDT program, this Note argues that, in most cases, states must provide Medicaid coverage for gender-affirming puberty blockers under the Medicaid Act.