‘Devastating:’ LGBTQ activists sound alarm on KY bill banning Medicaid-funded trans care

Two years ago, protests around a bill banning gender-affirming care for minors in Kentucky rocked the state Capitol.

Though Senate Bill 150 passed with support from the state’s overwhelming GOP legislative majorities, cries of protest filled the halls, committee meetings got testy and some protesters were arrested.

And now, many 2023 protesters say, House Bill 495 out of this year’s General Assembly is more harmful to the state’s LGBTQ community.

The bill was transformed Wednesday by a committee substitute that would ban Medicaid funds from supporting both gender reassignment surgery and hormone treatments, commonly referred to as hormone replacement therapy, used to help transgender people transition.

“It is going to be significantly more devastating (than SB 150),” Mason Kalinsky, a mainstay of opposition against GOP-led bills related to LGBTQ issues. “A lot of trans adults are on Medicaid.”

In fact, Kalinsky himself was a trans Kentuckian on Medicaid receiving hormone replacement therapy — referred to in House Bill 495 as “cross-sex hormones” — before he got a new job earlier this year.

“Honestly, I don’t know how a lot of people are going to be able to survive,” he recalled. “I had a period where I had to go off hormones just for a week due to a supply issue, and I don’t know how to explain how much it affects your mental health.”

The impact is more sweeping than what was this year’s marquee bill limiting gender-affirming care; Senate Bill 2, which bars gender-affirming care for the state’s prison population, was recently passed by the Senate.

House Bill 495 is the latest attempt by Republicans in Kentucky and across the country to restrict access to gender-affirming care.

Though a handful of states limit Medicaid coverage of all gender-affirming care through their Medicaid program, Kentucky would be just the second state to codify an explicit ban on coverage in state law.

Idaho passed such a ban on Medicaid spending, as well as any public funding, for gender-affirming care. It was blocked in federal court for several months but was allowed to continue in a January court ruling, though the issue is still being litigated.

Emma Curtis, a prominent trans rights activist who was elected to the Lexington-Fayette Urban County Council in 2024, said the bill is “designed to hurt people simply for being trans.”

“The amendment added today makes Senate Bill 150 look like chump change,” she said. “We knew when they started targeting transgender youth that eventually that would lead to them targeting transgender adults, despite their assurances to the contrary.

“It was only a matter of time.”

The current situation

The number of trans Kentuckians on Medicaid is unclear, though in the United States about 21% of trans adults, compared to 14% of non-trans adults, are covered by Medicaid, according to the Kaiser Family Foundation.

Also unclear is what Medicaid eligibility regulations already exist for gender-affirming care like hormone replacement therapy.

Senate President Robert Stivers, R-Manchester, said he sees the bill as a restoration of a previous limitation. He said Kentucky’s Medicaid program and its managed care organizations used to bar hormonal treatments and surgeries but no longer do.

The wording has indeed changed for at least one managed care organization. As far back as 2022, Wellcare of Kentucky wrote in a Medicaid provider manual that “gender reassignment services” were not to be covered.

However, in Kentucky’s most recent batch of managed care organization contract renewals — the state contracts with six different companies, including Wellcare — no such language barring gender-affirming care exists.

Advocates like Kalinsky and Kentucky Fairness Campaign Executive Director Chris Hartman say it’s their understanding that Medicaid in Kentucky has covered hormone treatments for years.

“I am very confident that trans folks are getting HRT (hormone replacement therapy) on state Medicaid right now,” Hartman said.

When asked to clarify the Cabinet for Health and Family Services’ stance on the issue, a spokesperson provided the Herald-Leader with a brief statement.

“Medicaid covers services that are deemed ‘medically necessary’; for a member by a provider, unless it is specifically prohibited by law. For example, current state law bans gender-affirming care for minors,” spokesperson Kendra Steele wrote.

Steele has yet to respond to Herald-Leader questions about the number of Kentuckians getting gender-affirming care or the total cost of that care.

Kalinsky and Curtis both said to their knowledge Medicaid has never covered gender reassignment surgeries — the other practice banned in the new House bill.

Staunch social conservative Rep. Josh Calloway, R-Irvington, wants even stricter limits on medical options for transgender Kentuckians.

His House Bill 154, which has not moved, bars Medicaid or state-funded health insurance program from funding counseling that “validates or affirms an individual’s perception of the individual’s sex, if that appearance or perception is inconsistent with the individual’s sex.”

Calloway has his own data set for how many transgender Kentuckians receive gender-affirming care via Medicaid, provided to him via by the Cabinet for Health and Family Services.

The cabinet told him his bill would cost the state up to $1.8 million due to 10,000 to 15,000 people accessing an additional six hours of behavioral health services per year, on top of $500,000 in state funds to defend anticipated lawsuits.

Calloway told the Herald-Leader he used that 10,000 to 15,000 figure as a rough estimate for the number of Kentuckians receiving gender-affirming services through the Medicaid program.

However, in a publicly posted fiscal note to the bill, the administration of Gov. Andy Beshear amended the number of people needing increased mental health services to 5,000-10,000.

What’s next?

Though it passed the House earlier this month, the newly configured House Bill 495 would need to pass both the Senate and the House to be sent to Beshear’s desk.

Any bill hoping to survive a potential veto from Beshear — the governor vetoed 2023’s Senate Bill 150 — would need to be passed by Friday.

Stivers told reporters Wednesday he expects to pass it out of the Senate, but House leadership was not available to comment on the fate of the bill Wednesday evening.

The bill’s opponents argued that the quick and relatively discreet passage of the bill shows that the legislature doesn’t want to reckon with public blowback.

“To see them take the same tactics that they took two years ago with the passage of SB 150 shows that these bills still don’t have popular support in Kentucky,” Curtis said.

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