Minnesota is a safe haven for transgender youth, but that could end under Trump administration

Minnesota has long been a safe haven for transgender youth, but new moves by the Trump administration to ban gender-affirming care put that status in jeopardy. 

One of the proposed rules would withhold all Medicaid and Medicare funding from hospitals that provide any gender-affirming care to anyone under the age of 18, even if that care is paid for by private insurance or by families out of pocket.

Those federal program dollars make up a significant portion of hospitals’ revenue. The health policy nonprofit KFF reports that Medicaid and Medicare made up nearly 45 percent of all hospital care spending in 2023, and many hospitals would likely not survive without it.

The other rule proposed last week by the Trump administration would prohibit the use of Medicaid funds to provide gender-related care, including puberty blockers, hormone therapy and surgery, to transgender youth under 18, making it more difficult for patients on the low-income health insurance program to get this care.

Dr. Kade Goepferd is a pediatrician and founder of the Gender Health program at Children’s Minnesota, one of the hospitals that currently provides this type of care to trans youth. Goepferd said that while this isn’t technically a proposed ban on care, the effects will be the same: No hospital in the country can survive without this federal funding. 

“It's sort of a forced choice that's being proposed with these rules,” Goepferd said. “You can either continue to fund your hospital and fund care for all kids, or you can stop providing certain care for transgender kids, and that's just not a choice that hospitals should have to make.”

“We don't want funding restrictions or government rules standing between families and their doctors,” Goepferd added. “That's not good medical care. We want medical decisions that are really based on science and evidence and long-standing guidelines, and we want families to be able to get that care from care teams that they trust and that they’ve worked with over time.”

These rules could have an outsized effect in Minnesota, where hospitals serve not just  transgender youth from within the state but patients who have traveled here from other states that have bans on gender-affirming treatment to get care. In 2023, Minnesota’s legislature passed a law declaring the state a “trans refuge,” protecting gender-affirming care here. 

Gender health advocates say the Trump administration’s virtual ban on gender care could have a chilling effect, and Goepferd said it could be especially devastating for families that moved to Minnesota to get care. 

“They have, in some cases, uprooted their entire lives to move to a state simply to access health care that their child needs,” Goepferd said, “and now they're being told that they might be in a position where it's going to become even more challenging.”

‘Life-saving’ care

Gender care is a wide umbrella. It could involve discussions around changing a child’s physical appearance through a hair cut or clothing, or even shape wear. In some cases, the families and their care teams may decide to pursue hormonal medications, like puberty blockers, that pause puberty changes — and can be reversed, if need be.

Goepferd said surgery is incredibly uncommon for transgender youth. In fact, Children’s Minnesota doesn’t offer that service. 

Advocates say access to such care is not just life changing but life saving. A mother in Minneapolis told MPR News it is exactly that for her 13-year-old son. He was assigned female at birth but began to identify as male when he was in third grade. As physical changes during puberty started to kick in, she said her “happy-go-lucky” kid became increasingly distressed and he even began harming himself. MPR News agreed to not disclose her name because of concerns she has for her kid’s safety.

“As a parent, I was really concerned about suicide,” she said. “It was really, really scary. And I know how many trans youth try to end their lives. Just thinking of my sweet baby being so distraught with his body and with his situation that that was something he was contemplating, that just sent me over the edge. I felt like anything that I can do to help him be here and be alive and be happy in life again, I am on board.”

The family and her son’s care team eventually decided to have her son start on puberty blockers. It was by no means a casual decision. He was scared of needles, so he did therapy for months to work through that fear just so that he could get the bloodwork that he needed to obtain the medication. 

She said talking to the doctors was reassuring — they said the medication was like he’s able to hit a pause button on physical changes during puberty, giving her son more time to think through who he is and what kind of future he wants to have. 

“What's odd is that people who are on the other side of this issue, who think that this is harmful, are worried that we're pushing kids into making decisions,” she said. “But we're actually doing the exact same thing that they want to do, which is not push kids into these decisions and give time for kids to be able to think really carefully about big choices.”

‘Facing scary decisions’

Hannah Edwards is the executive director of Transforming Families, a peer-led support group for gender-diverse youth and their caregivers that meets across the state. She said in the last year, 200 families have reached out to her nonprofit who are moving to Minnesota. 

Now, she says she knows of several families who are seriously thinking about leaving the country. 

“A lot of parents are facing pretty scary decisions — ‘Do we leave the country? Can we leave the country? Can we afford that?’ — because they know that this is life-saving care, and to take it from your child is not a choice that you're going to make,” Edwards said.

Edwards says she is confident that Minnesota has leaders in place who will fight hard to protect the rights of trans youth. 

Last week, a number of DFL legislators spoke out against the proposed rules, including Democratic Gov. Tim Walz. 

Attorney General Keith Ellison said in a statement that he and his office are reviewing the proposed rules and that he is “committed to vigorously defending Minnesota’s medical providers who do incredible work to treat and care for all Minnesotans, including our transgender neighbors.”

“We've got such a strong, beautiful community that I think we're going to really fight hard to keep that access to care,” Edwards said. “But it is scary.”

And this is very personal for Edwards. Her 15-year-old daughter is trans, and she said her daughter is happy and healthy because of the protections that are in place in Minnesota. She said if the federal rules are enacted, it would harm her own family as well as hundreds of others she works with every day. 

MPR News asked Edwards if she’s thinking of moving her family out of the country if the rules are enacted.

“It's not off the table,” she said.

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