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Missouri Supreme Court Upholds Ban on Youth Gender-Affirming Care and Medicaid Coverage for All Ages

Applying rational-basis review, the court said there is no fundamental right to treatments the legislature barred.

Overview

  • The unanimous ruling in E.N. v. Kehoe affirms a 2024 Cole County decision upholding Senate Bill 49.
  • Judge Kelly Broniec’s opinion rejected heightened scrutiny and found no sex- or transgender-based discrimination, saying the law classifies by medical use and age.
  • Missouri’s statute prohibits puberty blockers, cross-sex hormones, and transition surgeries for minors, and adults may receive such care only if paying out of pocket.
  • The court sustained the exclusion of gender-affirming care from Medicaid for all ages, citing the state’s interest in efficient use of limited public funds.
  • The decision tracks recent federal rulings on Tennessee and Arkansas laws, as the ACLU of Missouri and Lambda Legal say they will explore further legal options and advocacy groups expand support resources.