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Missouri Policy Journal

Abstract

The Save Adolescents from Experimentation (SAFE) Act is a law enacted in August 2023 that banned gender-affirming medical care for individuals under 18 in Missouri. It states that any medical provider who provides medical gender-affirming care to a minor will have their professional medical license revoked. The purpose of this policy review is to evaluate and compare the content of the Missouri SAFE Act with similar legislation enacted in other states to provide an evaluative model.        

This policy assessment used a modified assessment tool that was developed by the Centers for Disease Control and Prevention (CDC). The assessment included a synthesis of the SAFE policy using the legislation-tracking platform BillTrack50. A rapid literature review was conducted to compare the contents of the Missouri SAFE Act with those of other states with similar policies.

Research Highlights

  • The Problem: Missouri's Save Adolescents from Experimentation (SAFE) Act, enacted in 2023, prohibits medical gender-affirming care (GAC) for transgender and gender-nonconforming minors, impacting healthcare access and professional licensing for providers. 

  • The Method: Researchers applied the Centers for Disease Control (CDC) policy evaluation framework, conducting a rapid literature review of BillTrack50, the Missouri Senate website, and PubMed to compare Missouri's legislation with 39 other state-level policies enacted between 2021 and 2024. 

  • Quantitative Finding: The SAFE Act limits medical services for approximately 2,900 to 3,000 transgender youth in Missouri; Nationwide, approximately 105,000 minors (35% of the 300,000 transgender youth in the U.S.) live in states with GAC bans; 108 Republican representatives voted for the bill against 47; Missouri is one of at least six states prohibiting public funds for GAC; only five states (Alabama, Florida, Idaho, North Dakota, Oklahoma) include felony charges for providers. 

  • Qualitative Finding: The SAFE Act is more restrictive than some states by banning all types of medical GAC (hormones, puberty blockers, and surgery) and limiting Medicaid coverage for adults, yet less restrictive regarding penalties as it excludes felony charges and includes a grandfather clause for existing patients. 

  • Finding: State-level GAC bans create a "legal limbo" for physicians forced to choose between conflicting state mandates and federal non-discrimination laws, while the exclusion of gender-affirming procedures for transgender youth contrasts with the lack of similar legal restrictions for more prevalent cosmetic procedures performed on cisgender minors.

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