Missouri has enacted a new law restricting access to gender-affirming healthcare for incarcerated transgender people, marking a major shift in how the state’s Department of Corrections can provide medical treatment.
HB 2009, signed into law by Governor Mike Kehoe on 30 June, prohibits the use of state funds for hormone therapy and gender-affirming surgeries intended for gender transition.
Advocates warn the law could force transgender prisoners who are currently receiving hormone therapy to detransition while in custody.
Law targets transition-related care in prisons
The new provision was added to a broader corrections funding bill and was sponsored by state Representative Dirk Deaton.
During debate on the House floor in March, Deaton argued that lawmakers should determine how taxpayer funds are used for medical treatment in correctional settings.
“Because recall…these are people that have been adjudicated of a crime. They’ve been convicted of a crime. They have been sentenced to prison. They are incarcerated on the taxpayer’s dime, for their room and board and also for their healthcare – paid 100% by the taxpayer. And what is appropriate healthcare under those circumstances, that’s what this speaks to,” Deaton said.
Under the new law, Missouri’s Department of Corrections is required to discontinue state-funded gender transition-related treatments, affecting incarcerated people already receiving hormone therapy as well as those seeking to begin treatment while in custody.
Years of legal battles over prison healthcare
The move comes after years of legal and policy fights over transgender healthcare in Missouri prisons.
In 2018, a federal court ruling in Hicklin v. Precythe found that Missouri’s blanket denial of hormone therapy to transgender prisoners who had not received it before incarceration violated the Eighth Amendment’s prohibition on cruel and unusual punishment.
The ruling barred the Missouri Department of Corrections from enforcing its so-called “freeze-frame” policy, which denied hormone treatment to transgender prisoners unless they had already been receiving it before entering prison.
That decision required individualised medical care in some cases, including hormone therapy when deemed medically necessary. However, it did not extend to gender-affirming surgeries, which Missouri later restricted through separate legislation in 2023.
Missouri’s 2023 law also restricted Medicaid coverage for gender-affirming care, and the Missouri Supreme Court upheld those restrictions in January 2026.
Advocates warn of harm
LGBTQ+ and civil rights advocates have long argued that denying medically necessary gender-affirming care to incarcerated people can cause serious harm, particularly for those already diagnosed with gender dysphoria.
The new law raises fresh concerns about whether Missouri’s prison system will again face constitutional challenges over access to care.
For incarcerated transgender people, the impact could be immediate and severe: treatment they had been receiving may now be cut off, not because of a medical decision, but because lawmakers have chosen to block state funding.
Advocates say the result is likely to be forced detransition for some of the most vulnerable transgender people in the state.
