Idaho ban on gender-affirming care from Medicaid, government insurance coverage passes Legislature

A bill to ban Idaho public funds from covering gender-affirming medications and surgeries for Idaho adults and children heads to Idaho Gov. Brad Little for final approval.

House Bill 668 would ban public funds from paying for gender-affirming medications and surgeries. That would apply to Idahoans covered under Medicaid and Idaho’s state insurance plan, the Idaho Capital Sun previously reported.

The Idaho Senate passed the bill on a near party-line 26-8 vote on Friday. All seven Senate Democrats opposed it. Sen. Abby Lee, R-Fruitland, was the only Senate Republican to vote against the bill.

The Idaho House previously passed the legislation, backed by 58 House Republicans and opposed by all 11 House Democrats.

Major medical groups say gender-affirming care is medically necessary and safe.

Idaho Medicaid largely covers low-income and disabled people and insures around 300,000 Idahoans. About 62,000 Idahoans are insured through government employee insurance policies, which are set to switch to a new insurer this summer.

A study recently found that gender nonconforming people were at a higher risk for being in a lower socio-economic status. About 7,000 Idaho adults and 1,000 Idahoans age 13 and up are transgender, according to estimates from the University of California-Los Angeles.

Little has expressed support for banning Medicaid coverage for gender-affirming care. In May , he directed the Idaho Department of Health and Welfare to develop a policy to ban Medicaid coverage for gender-affirming care treatments for adults and children.

Gender-affirming surgeries were not performed on minors in Idaho before last year’s ban on the care for children was passed, the Idaho Capital Sun previously reported. The Idaho Department of Health and Welfare, which administers Medicaid, “has not covered any surgeries for gender dysphoria for adults or youth,” a spokesperson previously told the Idaho Capital Sun.

Sen. Ben Toews, R-Coeur d’Alene, told senators in floor debate on Friday that the bill ensures “taxpayer dollars are not used to pay for medically harmful treatments.”

“Responding to the brokenness of the world requires humility, compassion and wisdom. We don’t have enough of these things by ourselves. And it is only by the power of our creator, that healing is truly enabled. The answer to our affliction will not be contrived because wholeness is given, not manufactured,” Toews said.

Sen. Melissa Wintrow, D-Boise, called the bill discriminatory, and part of a “family of bills that clearly violates the 14th Amendment Equal Protection Clause.”

Ban draws on a previously passed bill, which judge temporarily blocked

Public employees or officers who intentionally violate the bill could face misuse of public funds charges.

If passed, House Bill 668 would still allow surgical procedures and medications used in gender-affirming care to use public funds in certain cases, like when it’s necessary for health. But the bill excludes it for the purpose “to affirm the individual’s perception” of their sex, the legislation states.

“Surgical operation or medical intervention is never necessary to the health of the minor or adult on whom it is performed if it is for the purpose of altering the appearance of an individual in order to affirm the individual’s perception of the individual’s sex in a way that is inconsistent with the individual’s biological sex,” the bill says.

House Bill 668 relies on definition for gender-affirming medication and surgeries created in Idaho law through last year’s House Bill 71. That law’s implementation has been blocked during litigation that’s been appealed to the U.S. Supreme Court.

House Bill 668 allows the following exceptions to the ban:

• When a surgical operation or medical intervention is “necessary to the health of the person on whom it is performed.”

• To treat infections, injuries or disorders “caused or exacerbated by … gender transition procedures.”

• And when “performed in accordance with the good faith medical decision of a parent or guardian of a child or an adult born with a medically verifiable genetic disorder of sex development.”

If passed, House Bill 668 would take effect July 1.

House Bill 71, which is temporarily blocked, would have banned gender-affirming care medications and surgeries for any child in Idaho, but not all gender-affirming care, the Idaho Capital Sun previously reported. But, the law’s implementation is temporarily blocked as a lawsuit challenging the legislation makes its way through the courts.

State property, facilities or buildings can’t be used “to provide the surgical operations or medical interventions” in that previous law.

Doctors or health care professionals employed by state, county or local governments can’t provide those services “in the course and scope of (public) employment.”

The bill would ban any gender-affirming care medications and surgeries “for purposes of altering the appearance of an individual in order to affirm the individual’s perception of the individual’s sex in a way that is inconsistent with the individual’s biological sex.”