Missouri Gov. Parson signed SB 49 SAFE Act banning gender-affirming care for minors and Medicaid coverage

On June 7, 2023, Missouri Gov. Mike Parson signed Senate Bill 49 (SS#2/SCS/SBs 49, 236 & 164), the "Missouri Save Adolescents from Experimentation (SAFE) Act," into law in Jefferson City. The act bars any health care provider from performing gender-transition surgeries on a minor and, until Aug. 28, 2027, from prescribing or administering cross-sex hormones or puberty-blocking drugs to a minor for the purpose of gender transition, unless the minor was already receiving such treatment before the law's Aug. 28, 2023 effective date. Passed by the Republican-controlled Missouri General Assembly and sponsored by Sen. Mike Moon, the bill was one of two anti-trans measures Parson signed that day.

Under the law, a violation is treated as unprofessional conduct and results in revocation of the provider's professional license, and the prescription or administration of the barred treatments creates a cause of action against the provider. The act also directs that the MO HealthNet (Medicaid) program not cover gender-transition surgeries, cross-sex hormones, or puberty blockers for gender transition for transgender people of any age, and bars gender-transition surgeries in state prisons and jails. Narrow carve-outs exempt treatment for medically verifiable disorders of sex development, care for injury or disease caused or exacerbated by prior gender-transition procedures, and procedures needed where a minor faces imminent danger of death or major bodily impairment. Announcing the signing, Parson said the state "must protect children from making life-altering decisions that they could come to regret in adulthood."

Updates

2023-08-29 — Cole County judge denied request to block SB 49 [4]

A Cole County Circuit Court judge denied a request by Lambda Legal, the ACLU of Missouri, and co-counsel to block SB 49, allowing the law to take effect Aug. 28, 2023.

2024-11-25 — Cole County court upheld SB 49 after trial in Noe v. Parson [5]

Following a nine-day trial in Noe v. Parson, the Cole County Circuit Court refused to halt enforcement of SB 49, upholding the ban on gender-affirming care for minors and the Medicaid coverage exclusion. Lambda Legal and the ACLU of Missouri said they would appeal.

2026-01-13 — Missouri Supreme Court upheld SB 49 in E.N. v. Kehoe [6, 7]

The Missouri Supreme Court unanimously upheld SB 49, applying rational-basis review and finding the law's age- and medical-use-based classifications "rationally related to legitimate state interests, such as safeguarding minors and managing public resources." The ruling, in the renamed case E.N. v. Kehoe (Gov. Mike Kehoe having succeeded Gov. Parson as named defendant), is the final decision on the merits from the state's highest court.