Missouri terminates emergency rule to limit trans care for minors, some adults

Missouri officials on Tuesday abruptly terminated an unusual emergency rule proposed by the Republican attorney general that would have placed limits on transgender care for minors and some adults.

The move was announced without explanation on the Missouri Secretary of State’s website, which said: “This emergency rule terminated effective May 16, 2023.”

The rule pushed by Attorney General Andrew Bailey would have required adults and children to undergo more than a year of therapy and fulfill other requirements before they could receive gender-affirming treatments such as puberty blockers, hormones and surgery.

Bailey said in a statement Tuesday evening that his office was “standing in the gap” until the GOP-controlled Legislature decided to act on the issue.

“The General Assembly has now filled that gap with a statute,” he said. “I’m proud to have shed light on the experimental nature of these procedures, and will continue to do everything in my power to make Missouri the safest state in the nation for children.”

House Minority Leader Crystal Quade, D-Springfield, said in a statement that Missouri should not have an attorney general “who persecutes innocent Missourians for political gain.”

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“Andrew Bailey grossly overstepped his legal authority, and everyone knows it,” she said. “So it isn’t surprising he withdrew his unconstitutional rule knowing another embarrassing court defeat was inevitable.”

Bailey had sought to implement the rule on April 27. But the ACLU of Missouri filed a lawsuit to stop it, arguing that Bailey bypassed the Legislature and did not have the authority to regulate health care through Missouri’s consumer-protection law.

St. Louis County Judge Ellen Ribaudo later granted a temporary restraining order and scheduled a hearing for July 20.

The law’s termination comes less than a week after the Missouri Legislature approved a ban on minors starting care. Gov. Mike Parson, a Republican, who threatened to call a special session if lawmakers did not pass that bill and another banning transgender girls and women playing on female school sports teams, is expected to sign the law.

Bailey’s proposed rule would have required people to have experienced an “intense pattern” of documented gender dysphoria for three years and to have received at least 15 hourly sessions with a therapist over at least 18 months before they could receive treatment. Prospective patients also would have been required to be screened for autism, and any psychiatric symptoms from mental health issues would have to be treated and resolved.

Legal experts and transgender advocates have said the rule would have made Missouri the first state in the country to restrict gender-affirming care for adults and the first to enact such restrictions through emergency rules rather than a new law.

Bailey said he proposed the rule to protect minors from what he called experimental medical treatments, though puberty blockers and sex hormones have been prescribed for decades and the rule would also apply to adults.

The attorney general’s office has said there are 12,400 Missourians who identify as transgender. The office has estimated that 600 to 700 Missourians would begin treatment in the next year.

Bailey issued the restrictions after he began an investigation in February into Washington University’s Transgender Center at St. Louis Children’s Hospital after a former employee alleged the center was providing children with gender-affirming care without informed consent, not enough individualized case review and wraparound mental health services.

The university’s internal review found the claims were unsubstantiated.