{"id":666609,"date":"2025-06-18T17:54:15","date_gmt":"2025-06-18T21:54:15","guid":{"rendered":""},"modified":"2025-08-13T09:07:46","modified_gmt":"2025-08-13T13:07:46","slug":"what-are-the-implications-of-the-skrmetti-ruling-for-minors-access-to-gender-affirming-care","status":"publish","type":"post","link":"https:\/\/www.kff.org\/lgbtq\/what-are-the-implications-of-the-skrmetti-ruling-for-minors-access-to-gender-affirming-care\/","title":{"rendered":"What are the Implications of the Skrmetti Ruling for Minors\u2019 Access to Gender Affirming Care?"},"content":{"rendered":"\n<div\n\tclass=\"wp-block-kff-shared-content--standard-layout wp-block-kff-shared-content\">\n\t\n\n<section class=\"wp-block-kff-shared-content-main\">\n\t\t\t<div class=\"post-header\">\n\t\t\t\t\t\n\t<h1 class=\"post-header__title\">What are the Implications of the Skrmetti Ruling for Minors\u2019 Access to Gender Affirming Care?<\/h1>\n\n\t\n\t\t\t<div class=\"post-header__meta\">\n\t\t\t\t\t<div>\n\t\t\t\t<span class=\"post-header__meta-label\">\n\t\t\t\tAuthors:\t\t\t\t<\/span>\n\t\t\t\t<a href=\"https:\/\/www.kff.org\/person\/lindsey-dawson\/\">Lindsey Dawson<\/a> and <a href=\"https:\/\/www.kff.org\/person\/laurie-sobel\/\">Laurie Sobel<\/a> \t\t\t<\/div>\n\t\t\t\t<div>\n\t\t\t<span class=\"post-header__meta-label\">Published:<\/span>\n\t\t\t<date>Jun 18, 2025<\/date>\n\t\t<\/div>\n\t\t<\/div>\n\t\n\t<div class=\"post-header__social-sharing\">\n\t\t<button class=\"post-header__social-sharing__button print\">\n\t\t\t<svg width=\"16\" height=\"17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n\t\t\t\t<path d=\"M4.348 2.5v3.391H2.783A.787.787 0 0 0 2 6.674v4.696c0 .429.353.782.783.782h1.565V14.5h7.304v-2.348h1.565c.43 0 .783-.353.783-.782V6.674a.787.787 0 0 0-.783-.783h-1.565V2.5H4.348Zm.522.522h6.26v2.87H4.87v-2.87ZM2.783 6.413h1.782a.26.26 0 0 0 .085 0h6.697a.26.26 0 0 0 .086 0h1.784c.148 0 .261.114.261.26v4.697c0 .147-.113.26-.26.26h-1.566V9.283H4.348v2.347H2.783a.257.257 0 0 1-.261-.26V6.674c0-.147.113-.261.26-.261Zm9.39.783a.522.522 0 1 0 0 1.043.522.522 0 0 0 0-1.043ZM4.87 9.804h6.26v2.043a.264.264 0 0 0 0 .086v2.045H4.87v-2.043a.261.261 0 0 0 0-.085V9.804Zm1.043.783a.262.262 0 0 0-.265.26.26.26 0 0 0 .265.262h4.174a.26.26 0 1 0 0-.522H5.913Zm0 1.043a.26.26 0 1 0 0 .522h3.13a.26.26 0 1 0 0-.522h-3.13Zm0 1.044a.26.26 0 1 0 0 .522h4.174a.262.262 0 0 0 .264-.261.26.26 0 0 0-.264-.261H5.913Z\" fill=\"#004B88\" stroke=\"#004B88\" stroke-width=\".5\"\/>\n\t\t\t<\/svg>\n\n\t\t\tPrint\t\t<\/button>\n\t\t<a href=\"mailto:?subject=What%20are%20the%20Implications%20of%20the%20Skrmetti%20Ruling%20for%20Minors%E2%80%99%20Access%20to%20Gender%20Affirming%20Care%3F&#038;body=https%3A%2F%2Fwww.kff.org%2Flgbtq%2Fwhat-are-the-implications-of-the-skrmetti-ruling-for-minors-access-to-gender-affirming-care%2F\" class=\"post-header__social-sharing__button\">\n\t\t\t<svg width=\"16\" height=\"17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n\t\t\t\t<path d=\"M2.333 4.25h-.25v9.14h12.5V4.25H2.333Zm1.083 1.693-.353-.2V5.23h10.54v.513l-.353.2L8.333 8.73 3.416 5.943Zm-.353 6.467V6.884l.107.06 5.04 2.857.123.07.123-.07 5.04-2.857.107-.06v5.526H3.063Z\" fill=\"#004B88\" stroke=\"#004B88\" stroke-width=\".5\"\/>\n\t\t\t<\/svg>\n\n\t\t\tEmail\t\t<\/a>\n\t\t<button class=\"post-header__social-sharing__button copy\">\n\t\t\t<svg width=\"16\" height=\"17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n\t\t\t\t<path d=\"M11.533 2.9c-.615 0-1.23.235-1.697.702L8.502 4.936a2.4 2.4 0 0 0-.575 2.46l.958-.958a1.32 1.32 0 0 1 .371-.748l1.334-1.333a1.331 1.331 0 0 1 1.886 0c.52.52.52 1.365 0 1.885l-1.334 1.333c-.21.21-.474.331-.748.372l-.958.958a2.393 2.393 0 0 0 2.46-.576l1.334-1.333a2.402 2.402 0 0 0 0-3.394 2.393 2.393 0 0 0-1.697-.702Zm-1.61 3.46a.533.533 0 0 0-.367.162l-3.2 3.2a.533.533 0 1 0 .754.754l3.2-3.2a.534.534 0 0 0-.387-.915ZM6.586 7.973a2.388 2.388 0 0 0-1.816.697l-1.334 1.333a2.403 2.403 0 0 0 0 3.394 2.393 2.393 0 0 0 1.697.702c.614 0 1.229-.234 1.697-.702l1.333-1.334a2.4 2.4 0 0 0 .576-2.46l-.959.958a1.32 1.32 0 0 1-.37.749l-1.334 1.333a1.334 1.334 0 0 1-1.886-1.885l1.334-1.334c.21-.21.474-.331.748-.372l.958-.957c-.21-.07-.426-.11-.644-.122Z\" fill=\"#004B88\"\/>\n\t\t\t<\/svg>\n\n\t\t\t<span>Copy Link<\/span>\n\t\t<\/button>\n\t\t\t<\/div>\n\t<\/div>\n\t\t\t\n<p class=\"wp-block-paragraph\">On June 18, 2025, the U.S. Supreme Court ruled (6-3) in <a href=\"https:\/\/www.supremecourt.gov\/opinions\/24pdf\/23-477_2cp3.pdf\"><em>United States v. Skrmetti<\/em><\/a>, upholding the lower court\u2019s ruling that a Tennessee law (SB1) banning gender affirming care for minors does not violate the U.S Constitution\u2019s 14<sup>th<\/sup> amendment equal protection clause. The Tennessee law, along with other states\u2019 laws restricting gender affirming care, may stand. Access to gender affirming care in states without bans is not impacted by this decision.<\/p>\n\n<p class=\"wp-block-paragraph\">As explained in the KFF brief, <a href=\"https:\/\/www.kff.org\/other\/issue-brief\/what-to-know-ahead-of-the-supreme-court-case-on-youth-access-to-gender-affirming-care\/\">What to Know Ahead of the Supreme Court Case on Youth Access to Gender Affirming Care<\/a>, the Supreme Court granted review for<em> Skrmetti<\/em> to resolve a split among circuits, and the ongoing questions about the constitutionality of these bans (see that brief for more background on the case). <a href=\"https:\/\/www.supremecourt.gov\/qp\/23-00477qp.pdf\">The question<\/a> the Court considered was whether Tennessee\u2019s ban on gender affirming care for minors violates the Equal Protection Clause of the Fourteenth Amendment. Embedded in its assessment, the Court considered whether the law results in sex-based classification and therefore should be reviewed with \u201cheightened scrutiny\u201d \u2013 that is, to show that the law is substantially related to achieving an important government objective \u2013 as opposed to the looser standard of \u201crational basis,\u201d which only requires the state to show the law has a rational relation to the state\u2019s legitimate objective.<\/p>\n\n<h2 id=\"what-did-the-court-decide\" class=\"wp-block-heading\">What did the Court decide?<\/h2>\n\n<p class=\"wp-block-paragraph\">The Court found that because the Tennessee law classifies people based on age and medical diagnosis, it therefore does not discriminate on the basis of sex or transgender status and as such does not trigger heightened scrutiny and does not violate Constitutional Equal Protections guarantees. \u201cSB1 satisfies rational basis review. Under that standard, the Court will uphold a statutory classification so long as there is \u201cany reasonably conceivable state of facts that could provide a rational basis for the classification.\u201d<\/p>\n\n<p class=\"wp-block-paragraph\">Justice Sotomayor dissented, joined by Justice Jackson stating that because SB 1 does classify individuals based on sex, the Court should use heightened scrutiny, and SB 1 would fail under heightened scrutiny. Justice Kagan joined most parts of Justice Sotomayor\u2019s decision except she filed a separate dissent to clarify she has no conclusion about whether SB 1 would satisfy heightened scrutiny.<\/p>\n\n<h2 id=\"what-is-the-impact\" class=\"wp-block-heading\">What is the impact?<\/h2>\n\n<p class=\"wp-block-paragraph\">The result of the Court\u2019s ruling means that most of the bans on gender-affirming care enacted by other states may stand as well. As of June 2025, <a href=\"https:\/\/www.kff.org\/other\/dashboard\/gender-affirming-care-policy-tracker\/\">27 states<\/a> that have enacted gender affirming care bans for minors. Bans in 25 states remain in place as a result of the ruling. Bans in Montana and Arkansas are currently permanently blocked by court order. The challenge in Montana relates to the state constitution and not federal law, and is therefore not directly impacted by the decision and the law remains blocked. A federal court blocked the Arkansas law, finding it unconstitutional based on both the Equal Protection <em>and <\/em>Due Process clauses. The Due Process claim was brought by parents stating the law took away their ability to make decisions regarding their child&#8217;s healthcare. This injunction remains in place given its basis on Due Process claims. The bans in Arizona and New Hampshire restrict only surgical care, which was not at issue before the Supreme Court, and remain in effect. Ultimately, this case leaves the patchwork of access to gender affirming care for young people in the United States in place. If a minor lived in a state without access before the decision, that access remains barred. If a minor had access to gender affirming care prior to the decision, that access remains.<\/p>\n\n<p class=\"wp-block-paragraph\">There was some question as to whether the Court would apply the reasoning in <em>Bostock, <\/em>an earlier case which found that in the employment setting, sex discrimination protections apply to gender identity and sexual orientation in hiring and firing. But the Court did not do so, stating, \u201cThe Court declines to address whether Bostock\u2019s reasoning reaches beyond the Title VII [employment] context\u2014unlike the employment discrimination at issue in Bostock, changing a minor\u2019s sex or transgender status does not alter the application of SB1.&#8221;<\/p>\n\n<p class=\"wp-block-paragraph\">Notably, the Supreme Court heard this case narrowly on the basis of Equal Protection claims and many cases challenging state laws have been argued on multiple other grounds (including this case at the district and appellate courts). As noted, a federal district court has <a href=\"https:\/\/assets.aclu.org\/live\/uploads\/2021\/05\/283-Findings-of-Fact-and-Conclusions-of-Law.pdf\">permanently blocked<\/a> a similar ban on gender affirming care for minors in Arkansas, finding the ban violates the due process rights of parents of transgender minors. It is likely that additional cases will be filed against other state bans on due process grounds, and ultimately the Supreme Court could review a case in a future term raising 14<sup>th<\/sup> Amendment Due Process, <a href=\"https:\/\/www.kff.org\/affordable-care-act\/issue-brief\/the-biden-administrations-final-rule-on-section-1557-non-discrimination-regulations-under-the-aca\/\">Section 1557<\/a> (the Affordable Care Act\u2019s major non-discrimination protections), or other claims. Additionally, as noted, the Montana Supreme Court has blocked its state ban on gender affirming care for minors based on provisions in the state constitution. Litigation challenging gender affirming care based on provisions in state constitutions will also continue in state courts, , and will likely result in varying interpretations of state constitutional protections for transgender minors.<\/p>\n\n\n<div class=\"datawrapper-embed block--datawrapper-embed \">\n\t\t\t\t\t<div style=\"min-height: 697px;\">\n\t\t\t<script\n\t\t\t\ttype=\"text\/javascript\"\n\t\t\t\tdefer\n\t\t\t\tsrc=\"https:\/\/datawrapper.dwcdn.net\/GT76a\/embed.js?v=14\"\n\t\t\t>\n\t\t\t<\/script>\n\t\t<\/div>\n\t\t\t<img\n\t\t\tclass=\"datawrapper-embed__print-img\"\n\t\t\tsrc=\"https:\/\/datawrapper.dwcdn.net\/GT76a\/full.png\"\n\t\t\talt=\"25 State Laws that Prohibit Minor Access to Gender Affirming Care Remain in Place\"\n\t\t\/>\n<\/div>\n\n\n<p class=\"wp-block-paragraph\">As a result of the decision, minors across the US will continue to see their access to gender affirming care determined at least in part based on where they live. However, access to these services is being debated in venues beyond the judiciary, including in Congress and by the Trump Administration.<a href=\"https:\/\/www.kff.org\/other\/fact-sheet\/overview-of-president-trumps-executive-actions-impacting-lgbtq-health\/\">\u00a0The Trump Administration<\/a> has taken a range of actions aimed at limiting access to gender affirming care, especially for minors and Congress too has taken up the issue. The\u00a0<a href=\"https:\/\/www.kff.org\/tracking-the-medicaid-provisions-in-the-2025-budget-bill\/\">reconciliation bill<\/a> still being finalized includes a prohibition on Medicaid covering gender affirming care in Senate and House-passed versions. These efforts will likely face, and some cases already have faced, litigation. While the ruling on this case is quite limited (narrowly focused on equal protection claims and Tennessee\u2019s ban), it could have some bearing on the outcome of future challenges.<\/p>\n \n\t<div class=\"post-footer\">\n\t<div class=\"post-footer__title\">More On<\/div>\n\t<div class=\"post-footer__links\">\n\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.kff.org\/topic\/lgbtq\/\">\n\t\t\t\tLGBTQ\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.kff.org\/topic\/other-health\/\">\n\t\t\t\tOther Health\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.kff.org\/tag\/access-to-care\/\">\n\t\t\t\tAccess to Care\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.kff.org\/tag\/adolescents\/\">\n\t\t\t\tAdolescents\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.kff.org\/tag\/courts\/\">\n\t\t\t\tCourts\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.kff.org\/tag\/gender-identity\/\">\n\t\t\t\tGender Identity\t\t\t<\/a>\n\t\t\t<\/div>\n<\/div>\n\t<\/section>\n\n<section class=\"wp-block-kff-shared-content-sidebar\">\n\t\t\t\n\t\t\n<div class=\"wp-block-kff-shared-related-content--green wp-block-kff-shared-related-content\">\n\t<h2 class=\"wp-block-kff-shared-related-content__heading\">Also of Interest<\/h2>\n\t<div>\n\t\t\t<div class=\"wp-block-kff-shared-related-content__card\">\n\t\t\t<a href=\"https:\/\/www.kff.org\/other-health\/what-to-know-ahead-of-the-supreme-court-case-on-youth-access-to-gender-affirming-care\/\" class=\"wp-block-kff-shared-related-content__link\">\n\t\t\t\t<h3 class=\"wp-block-kff-shared-related-content__card-title\">\n\t\t\t\t\tWhat to Know Ahead of the Supreme Court Case on Youth Access to Gender Affirming Care\t\t\t\t<\/h3>\n\t\t\t\t\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t<div class=\"wp-block-kff-shared-related-content__card\">\n\t\t\t<a href=\"https:\/\/www.kff.org\/other-health\/president-trumps-executive-order-on-gender-affirming-care-responses-by-providers-states-and-litigation\/\" class=\"wp-block-kff-shared-related-content__link\">\n\t\t\t\t<h3 class=\"wp-block-kff-shared-related-content__card-title\">\n\t\t\t\t\tPresident Trump\u2019s Executive Order on Gender Affirming Care: Responses by Providers, States, and Litigation\t\t\t\t<\/h3>\n\t\t\t\t\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t<div class=\"wp-block-kff-shared-related-content__card\">\n\t\t\t<a href=\"https:\/\/www.kff.org\/lgbtq\/gender-affirming-care-policy-tracker\/\" class=\"wp-block-kff-shared-related-content__link\">\n\t\t\t\t<h3 class=\"wp-block-kff-shared-related-content__card-title\">\n\t\t\t\t\tPolicy Tracker: Youth Access to Gender Affirming Care and State Policy Restrictions\t\t\t\t<\/h3>\n\t\t\t\t\t\t\t<\/a>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\n\n\t\t\t<\/section>\n\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>This policy watch examines the June 18 Supreme Court ruling upholding a Tennessee ban on gender-affirming care for transgender youth in the case of the United States v. Skrmetti, how it will affect access in other states with similar bans, and other implications.<\/p>\n","protected":false},"author":155412869,"featured_media":666628,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"authors":[{"type":"foundation","id":127159,"name":""},{"type":"foundation","id":94555,"name":""}],"exhibits":[],"jetpack_post_was_ever_published":false,"ep_exclude_from_search":false,"_classifai_error":"","_classifai_text_to_speech_error":"","hide_from_search":false,"show_featured_image":false,"subheading":"","tag":"","search_keywords":"Blog, 10736, Lindsey Dawson, Laurie Sobel","_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"shortlink":"","footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"enabled":false},"version":2}},"categories":[417697712,1035],"tags":[632330,170561,9862,155118268],"series":[],"partner":[],"content-types":[579145488],"program":[10084862,579144999],"class_list":["post-666609","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-lgbtq","category-other-health","tag-access-to-care","tag-adolescents","tag-courts","tag-gender-identity","content-types-policy-watch","program-hiv-policy","program-womens-health-policy"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v25.9 (Yoast SEO v25.9) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>What are the Implications of the Skrmetti Ruling for Minors\u2019 Access to Gender Affirming Care? | KFF<\/title>\n<meta name=\"description\" content=\"This policy watch examines the June 18 Supreme Court ruling upholding a Tennessee ban on gender-affirming care for transgender youth in the case of the United States v. 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