South Carolina enacted FY2022-23 budget Proviso 23.4, barring MUSC from using state funds for gender-affirming care for transgender minors under 16

On July 1, 2022, South Carolina's FY2022-23 General Appropriations Act (H.5150, Act No. 239, R.271) took effect carrying Proviso 23.4, which bars the Medical University of South Carolina (MUSC) from using state appropriated funds to "fund or support any action furthering the gender transition of a minor child under the age of sixteen," while not prohibiting medically necessary care unrelated to gender transition. The General Assembly's House-Senate budget conference committee adopted the provision in its June 15, 2022 report, passed by roll-call votes of 107-8 in the House and 40-2 in the Senate; Governor Henry McMaster's June 22 line-item veto message left the proviso in place while striking or sustaining vetoes on other, unrelated budget items.

Proviso 23.4 uses the state's appropriations power to withhold public hospital funding for one category of care sought specifically by transgender minors, a restriction that does not apply to any other patient population or form of care at the same publicly funded teaching hospital. South Carolina has renewed the same funding restriction in every subsequent budget cycle, including the FY2025-26 act recorded elsewhere in this archive (entries/2025/06/03/sc-discriminatory-policy-1a65720b.yaml).

Updates

2022-12-16 — MUSC ended pediatric transgender clinic care citing Proviso 23.4 [3]

In mid-December 2022, the Medical University of South Carolina announced it no longer held pediatric/adolescent transgender clinics and had stopped providing pediatric transgender hormonal care, with a spokesperson stating MUSC "has worked diligently to make sure that we are in compliance with the 2022-2023 Appropriations Act and proviso 23.4 and will do the same with any future legislative requirements/directives." The South Carolina Freedom Caucus, which had pressed MUSC on the issue, called the decision "a huge win."