Missouri Supreme Court Unanimously Upholds Ban on Gender-Affirming Care for Transgender Minors and Medicaid Restrictions

Jefferson City, Missouri – In a unanimous decision issued on Tuesday, January 13, 2026, the Missouri Supreme Court upheld Senate Bill 49, known as the SAFE Act, which bans gender-affirming medical care including surgeries, cross-sex hormones, and puberty blockers for transgender individuals under 18 and prohibits state Medicaid coverage for such treatments for people of all ages.

Judge Kelly Broniec, writing for the court, stated that prohibiting these surgeries does not violate the rights of transgender children and that parents do not have a fundamental right to obtain medical treatments for their children that the state legislature deems inappropriate for minors. The opinion emphasized that the law classifies based on age and medical use, applying to any individual under 18 without discrimination on transgender status alone.

Senate Bill 49 took effect on August 28, 2023, and also threatens health care professionals with loss of medical licenses for providing such care to minors. The ban is temporary, set to expire in 2027, though lawmakers have indicated plans to make it permanent, and a ballot initiative is slated for November to extend prohibitions indefinitely.

The ruling came in the case E. N. v. Kehoe, filed in July 2023 in Cole County Circuit Court by Lambda Legal, the ACLU of Missouri, and Bryan Cave Leighton Paisner LLP on behalf of three families with transgender young people, medical providers, PFLAG National, and GLMA: Health Professionals Advancing LGBTQ+ Equality. Plaintiffs argued the law unconstitutionally interferes with parental rights to medical decision-making, violates equal protection and due process under the Missouri Constitution, and discriminates against transgender people by denying treatments available to cisgender minors, such as hormones or puberty blockers for other conditions.

After a lower court denied preliminary relief and upheld the ban following a two-week trial in October 2024, advocates appealed to the Missouri Supreme Court, which heard arguments on January 16, 2025, before issuing its decision. The court also affirmed the Medicaid restrictions, citing "medical and scientific uncertainties"and lack of accepted standards of practice for these treatments.

LGBTQ+ advocacy organizations swiftly condemned the ruling. "Today's decision allows the state to continue to enforce a harmful ban that singles out transgender Missourians and denies them compassion and equal access to medically necessary health care, "said Gillian Wilcox, Director of Litigation at the ACLU of Missouri. "The decision 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."

Nora Huppert, Senior Attorney at Lambda Legal, stated, “We are deeply disappointed by today’s ruling, which allows for the continued violation of the fundamental constitutional rights of transgender Missourians. ” She added that the decision departs from Missouri’s protections of equal rights and opportunity, and Lambda Legal will explore further legal avenues.

Missouri Attorney General Catherine Hanaway praised the outcome, saying, “This win sends a clear message: Missouri will always protect children from dangerous, untested, and experimental procedures. ” The decision referenced the U. S. Supreme Court's 2025 upholding of Tennessee’s similar ban on gender-affirming care for those under 18.

Medical groups like the American Academy of Pediatrics have opposed such restrictions, with President Susan J. Kressly previously calling them “a baseless intrusion into the patient-physician relationship. ” The ruling impacts transgender youth and adults relying on Medicaid in Missouri, amid a national trend of state-level restrictions on gender-affirming care.