Missouri Supreme Court upholds ban on youth gender-affirming care

The state’s highest court issued a unanimous decision upholding the state’s ban on gender affirming care for minors.

In a Jan. 13 hand down, the court affirmed the circuit court’s decision allowing the legislature’s law banning “health care providers from performing gender transition surgeries on, or prescribing or administering cross-sex hormones or puberty-blocking drugs for the purpose of assisting gender transitions to, minors,” to stand.

The law also includes a ban on Medicaid payments for these treatment options.

Challengers to the law included minors and their parents, as well as medical organizations and advocacy groups.

In their appeal from the circuit court, the challengers brought pre-enforcement constitutional claims, arguing that the law “violates due process, equal protection and the gains of industry clause,” and they challenged the facts presented at trial.

However, the judges found the challengers’ arguments lacking, writing in the 15-page opinion by Judge Kelly C. Broniec:

“Because challengers fail to demonstrate the SAFE Act and Medicaid ban contravene the constitution, the circuit court’s judgment is affirmed.”

The judges pointed to the U.S. Supreme Court’s recent decision in United States v. Skrmetti in their reasoning.

The opinion notes that though the challengers claimed the circuit court erred in finding they raised only facial challenges to the law, this court found that the challengers only mounted facial challenges. Broniec wrote that the only remedies requested seek to invalidate and prevent the enforcement of the law.

“Further, challengers’ allegations of constitutional violation apply broadly, outside of the individual challengers’ experiences,” she wrote. “The circuit court correctly determined challengers raised only facial challenges to the SAFE Act and Medicaid ban and, therefore, must demonstrate there is ‘no set of circumstances . . . under which the [statutes] would be valid.’ Challengers have not satisfied this burden.”

Additionally, the law satisfied a rational basis of review and did not violate the equal protection clause or due process, according to the court.

The opinion said the gains of industry clause the challengers claimed was violated does not apply in this case or to the Medicaid ban which precludes MO HealthNet from funding the care.

“Along with the constitutional violations raised, challengers also bring two allegations of error concerning the evidence adduced at trial. First, challengers argue the circuit court erroneously permitted two expert witnesses to testify about the nature of gender dysphoria as a diagnosis, arguing the experts are not qualified to render opinions about the topics discussed,” the court wrote. “Second, challengers argue the circuit court’s judgment is based on factual findings that are not supported by the record.”

The challengers’ factual arguments do not alter the court’s opinion because the court has already determined a rational basis exists on the record before the court to uphold the law and Medicaid ban, Broniec wrote.

Among the challengers to the case were the ACLU of Missouri, Lambda Legal and Bryan Cave Leighton Paisner, who argued the ban “unconstitutionally discriminates against transgender individuals by denying them access to medically necessary treatments that remain available to non-transgender people, while interfering with fundamental rights to medical decision-making and parental autonomy.”

In a statement after the ruling, the ACLU of Missouri wrote the decision “allows the state to continue to enforce a harmful ban that singles out transgender Missourians.”

“We are deeply disappointed by today’s ruling, which allows Missouri to continue violating the fundamental constitutional rights of transgender Missourians,” Nora Huppert, senior attorney at Lambda Legal added in the joint statement. “This discriminatory law invades the private relationship between patients, their families, and their doctors, denying transgender people access to safe and effective medical care. The Missouri Constitution protects the autonomy, equal rights, and opportunity for all people, and this law falls short of those principles. We will continue to explore every legal avenue to protect the rights and health of transgender people in Missouri.”

The case is: E.N., individually and as next friend and on behalf of her minor child, N.N., et al. v. Mike Kehoe, in his official capacity as Governor for the State of Missouri, et al. Case no.  SC100933.