Oklahoma Effectively Bans Gender-Affirming Care for Many Trans Adults

Senate Bill 904 has forced many doctors to stop providing gender-affirming care to adults, cut insurance coverage for many trans people, and severely strained the rest of the dwindling care network.

The Oklahoma Capitol in Oklahoma City | Image: Wikimedia Commons

On May 13th, Oklahoma Governor Kevin Stitt signed anti-trans Senate Bill 904 into law, which went into effect that day due to receiving a two-thirds majority in the legislature. As its sponsor, State Sen. Todd Gollihare, explained it, the law merely “determines the fiscal policy of Oklahoma to say whether the taxpayers will pay for [gender-affirming care].” Accordingly, Gollihare has primarily pushed it as a “bill prohibiting Medicaid funding for gender transition procedures.” And that part is true: SB 904 explicitly prohibits Medicaid coverage of gender-affirming care for all ages.

However, unlike the 12 other states that have implemented similar restrictions on Medicaid, Senate Bill 904 goes much further, stipulating that “no state property, facility, or building may be used to provide gender transition procedures, regardless of whether the procedures are provided to a minor or an adult.” As if that wasn’t enough, it also vaguely states that “public funds shall not be used, granted, paid, or distributed to any entity, organization, or individual for the provision or subsidy of any gender transition procedures.” Finally, it makes it a misdemeanor for state employees to allow public funds to be used for gender-affirming care, which carries up to one year of jail time and/or a $500 fine.

Taken together, these restrictions constitute an unprecedented assault on trans adults’ access to gender-affirming care. To understand why, it’s worth examining each of the three provisions individually, starting with the ban on Medicaid coverage. As mentioned above, SB 904 bans Medicaid coverage of gender-affirming care for all ages, and in Oklahoma, that’s a big deal: according to federal data, 468,547 Oklahoman adults—nearly 15%—are enrolled in Medicaid, the 3rd-highest adult enrollment rate among states that ban gender-affirming care coverage, after Kentucky and Louisiana.

For trans Oklahomans, this rate may be even higher. In 2022, UCLA’s Williams Institute estimated that 21.2% of transgender adults are enrolled in Medicaid, a rate 1.5x higher than that of the general population. Assuming uniformity, this means that as many as 23% of Oklahoman trans adults may be reliant on Medicaid and, as a result of SB 904, are no longer able to access the gender-affirming care they need.

Furthermore, 20% of working Oklahomans are employed by state or local governments, and now, their insurance plans can no longer provide coverage for gender-affirming care either. On top of that, an additional 5% of the state’s workforce is employed by the federal government, which cut gender-affirming care from its insurance plans earlier this year. And another 8% of Oklahomans get their healthcare through ACA individual plans—state-subsidized plans that are also subject to SB 904’s new restrictions on gender-affirming care.

Through this data, the picture becomes much clearer: gender-affirming care just got a lot more difficult to access in Oklahoma. As a result of SB 904, many trans Oklahomans will now find themselves having to pay out-of-pocket for the care they need—and until recently, were insured for—posing a potentially insurmountable financial barrier to medical transition, especially among those who rely on Medicaid.

Even for those who aren’t affected by these cuts, the story doesn’t end here. SB 904 bars state property from being used to provide gender-affirming care, and as StateImpact Oklahoma reported last month, this provision almost immediately forced the University of Oklahoma’s health system, OU Health, to stop offering this care. The impact of this is undoubtedly significant: OU Health is the largest health system in the state, and it employs over 1,300 physicians—nearly 27% of the state’s total of 4,868. OSU Health, which has been similarly affected, employs another 2.5% of the state’s physicians.

As such, this provision means that almost 30% of the state’s doctors are no longer legally allowed to provide gender-affirming care—something that alone would undoubtedly strain the already dwindling number of providers of that care in the state. But it somehow gets even worse: SB 904 also includes a ban on public funds from going towards “the provision or subsidy of any gender transition procedures,” and this part is much more vague.

Questions primarily center around the word ‘subsidy,’ and because Gollihare never clarified its meaning, providers have been left to form their own interpretations. Does it include only direct funding, or is a provider that receives state funds technically using those funds to subsidize gender-affirming care if it requires those funds to stay financially afloat? We don’t know the answer to that question, and like all vague anti-trans laws with criminal penalties, it leads to overcompliance. As the ACLU of Oklahoma’s legal director, Megan Lambert, put it in an interview with StateImpact Oklahoma, “folks are really hesitant to try to separate funding streams when any kind of commingling of those funds can result in a criminal misdemeanor.”

And what has followed is an unprecedented shortage of appointments for gender-affirming care. As of the writing of this story, Planned Parenthood’s location in Oklahoma City has only 4 appointments for gender-affirming care in the next 3 months. Tulsa has none. Last Friday, those figures were 6 and 2, respectively. Telehealth appointments, which are shared between all 5 states in Planned Parenthood’s ‘Greater Plains’ region, are also scarce, with only 8 available between now and September.

Meanwhile, locations in neighboring Arkansas, Kansas, Missouri, and Texas all have an abundance of appointments available later this week. It must also be stressed that these are the availability figures for a provider that isn’t directly affected by SB 904, as an executive order issued by the state’s governor last year has already banned Planned Parenthood from receiving state funds. According to reports, other clinics have been similarly swamped.

In other words, SB 904 has delivered a near-death blow to trans adults’ access to care in the state, regardless of insurance coverage status and ability to pay. In a bit of irony, this means that trans Oklahomans will have better luck finding care if they travel to states that have historically been much more hostile to trans people, like Kansas, Missouri, and Texas. But not everyone has that choice, with work schedules, costs, and vehicle access posing significant barriers.

As does incarceration: the state’s Department of Corrections has interpreted the new law to prohibit it from allowing those in its custody to access gender-affirming care, going as far as saying that “inmates arriving at an assessment and reception center, who are received with hormone therapy prescriptions, shall have that therapy discontinued.” The same is almost certainly true for county jails. Although Oklahoma doesn’t have a criminal bathroom law, it did just introduce a new crime targeted at trans people and their allies: spending state funds on gender-affirming care.

But above all, Senate Bill 904 provides a roadmap; a roadmap for other states to follow in curtailing gender-affirming care access for all ages, but also a roadmap for us to know what to expect and how to push back. As the Trump administration gears up to bar care centers that provide gender-affirming care to minors from accepting Medicare and Medicaid, SB 904 offers an important window into how that ban—and a hypothetical nationwide ban on care for at least some adults—will likely be enforced. And it also gives us the knowledge that this ban will not be absolute. Providers—however few—will push back.

However, for trans Oklahomans, the day that their state threatens care for trans adults has arrived. We can only hope that providers are able to meet the moment.