The Missouri Supreme Court today upheld Senate Bill 49, Missouri’s discriminatory ban on gender-affirming medical care for transgender adolescents and Medicaid coverage restrictions for transgender people of all ages. The decision in E.N. v. Kehoe allows the state to continue denying transgender adolescents in Missouri access to gender-affirming medical care and preventing transgender Missourians of any age from receiving Medicaid coverage for the same care.
Lambda Legal, the ACLU of Missouri, and Bryan Cave Leighton Paisner LLP argued that SB 49 unconstitutionally invades the fundamental rights to medical decision-making and parental autonomy and discriminates against transgender individuals by denying them access to treatments that remain available to non-transgender people.
“We are deeply disappointed by today’s ruling, which allows for the continued violation of the fundamental constitutional rights of transgender Missourians,” said Nora Huppert, Senior Attorney at Lambda Legal. “Today’s decision leaves in place a ruling premised on widespread factual errors advanced in defense of this law in the lower court and departs from longstanding principles inherent in Missouri’s constitutional protections of equal rights and opportunity.”
“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, should certain care ever fall into the political arena.”
Senate Bill 49, which took effect on August 28, 2023, bans transgender adolescents from receiving gender-affirming medical care, prohibits Medicaid coverage for gender-affirming care for transgender people of any age, and threatens health care professionals with the loss of their medical licenses for providing such care to minors.
In July 2023, Lambda Legal, the ACLU of Missouri, and Bryan Cave Leighton Paisner LLP filed E.N. v. Kehoe in Cole County Circuit Court on behalf of three families of transgender young people, medical providers, and the organizations PFLAG National and GLMA: Health Professionals Advancing LGBTQ+ Equality. After the court denied preliminary relief and later refused to halt enforcement following a two-week trial in October 2024, advocates appealed to the Missouri Supreme Court on January 16, 2025.