'What Now?' How Michigan Is Stepping Up for Patients Left Behind as Ohio Bans Gender-Affirming Healthcare

Heartbreak as neighbor state puts medical care for trans patients in peril

Published: February 16, 2024 | Last Updated: February 19, 2024

In what feels like a scene from a horrifying Orwellian nightmare, thousands of transgender Americans lost their lifelines in January when a bill banning gender-affirming care was passed in Michigan’s most populous neighbor to the south, Ohio. It’s a story playing out across the country in a clearly coordinated effort on the part of the national Republican party — a story that increasingly includes anti-trans representatives in places like Michigan that have so far remained safe for trans patients.

As of this writing, almost half of U.S. states have enacted laws restricting access to gender-affirming care and transgender athlete sports participation (including adult college students), and face criminal penalties for using the bathroom that aligns with their gender in certain public spaces like schools and state-sponsored colleges and universities. This is despite the well-documented benefits of gender-affirming care for minors and long-established criteria by major medical organizations including the American Academy of Pediatrics and the American Medical Association. Targeting the estimated 300,000 transgender youth across America has become a winning right-wing wedge issue in the 2020s.

Ohio’s anti-trans success inspires Michigan Republicans

In January, Rep. Josh Schriver, a Republican from Oxford, Michigan, was recorded in an online strategy meeting headed up by Rep. Gary Click, who authored the recently enacted Save Adolescents from Experimentation (SAFE) bill in Ohio. In the audio recording released Jan. 26, Schriver is adamant that restrictions on gender-affirming care must extend to adults. “In terms of endgame, why are we allowing these practices for anyone?” Rep. Schriver asked, as reported by independent journalist Erin Reed on her Substack Erin in the Morning. “If we are going to stop this for anyone under 18, why not apply it for anyone over 18?" Later, Schriver compared gender-affirming care to “self-mutilation” and “euthanasia.”

Michigan Representatives Brad Paquette and Tom Kunse and Michigan Senators Jonathan Lindsey and Lana Theis also took part in the call, which included a focus on how Michigan could emulate Ohio when it comes to chipping away at the rights of transgender Michiganders to access medical care and exist peacefully in public. For now, the state remains a relatively safe haven for transgender patients, but these activities underscore how important it is for the LGBTQ+ community that Democrats retain their majority in Michigan’s statehouse.

Ohio law will force patients to seek care out of state

Following the Senate vote in Ohio on Jan. 24, Human Rights Campaign President Kelley Robinson issued a statement that read in part, “These legislators have abdicated their responsibility to do what’s right for the Ohioans they represent, casting votes that they know full well will harm innocent children, all to appease the leader of the MAGA agenda. Despite the fact that they have no medical training, these politicians believe they know better than parents and transgender youth seeking health care. It’s shameful.” The Ohio Democrat Party is leading an effort to get a measure on the November ballot aimed at ending the rampant gerrymandering in that state, a move advocates feel would dramatically improve the legal landscape for LGBTQ+ Ohioans.

For a moment, it appeared that Ohio Gov. Mike DeWine had taken to heart the testimony and meetings he had with transgender youth and their families. After the legislature passed HR 68, which banned transgender healthcare and transgender sports participation for minors and college students, DeWine vetoed the measure. “Were I to sign House Bill 68, or were House Bill 68 to become law, Ohio would be saying that the state, that the government knows better what is medically best for a child than the two people who love that child the most, their parents," DeWine said in a press conference after the veto.

However, the governor also announced administrative rule proposals that would have catapulted Ohio to the top of the list of states with the most barriers to gender-affirming care access — not just for minors, but for adults, too, including those who have been receiving care for decades.

The proposed rules, which have since been removed from the proposed rule changes after fierce advocate pushback, would have required patients of all ages to establish care plans with a team that includes a psychiatrist, endocrinologist and a medical ethicist. Patients under 21 would have been required to undergo at least six months of mental health counseling before starting gender-affirming medication or surgery.

Still, a rule that providers would be barred from referring minors to treatment elsewhere, including clinics in nearby states like Michigan remains under consideration. It is already common for patients outside Michigan to travel to the state for their care, especially in the Southeast Michigan area, where comprehensive programs at places like Henry Ford Health attract so many minor patients that there is often a months-long waiting list for an initial evaluation.

After DeWine’s veto, the Ohio Congress and then the state’s Senate worked overtime to override it, laying the issue to rest Jan. 24 when the Senate cast a 24-8 vote along party lines. As news of the override rolled in, a private Facebook group focused on the parents of transgender youth across the country lit up with inquiries about where parents in Ohio could find the care their children would still need after the ban goes into effect April 23.

“What now? My kid has been on puberty blockers for years, but isn’t old enough for estrogen yet” a parent from northwest Ohio wrote on the page. “We’re screwed because we aren’t grandfathered in, right? Can we get estrogen in Michigan??” Another parent replied that they currently make bi-monthly, 10-hour road trips from Missouri to access care at a hospital in Michigan for their teen. “Get ready to spend a lot of time and money,” they wrote.

Michigan preparing for changing gender-affirming care landscape

Jay Kaplan, staff attorney for the ACLU of Michigan's LGBTQ+ Project, tells Pride Source that organizations and providers across the state are paying close attention to the rapidly changing gender-affirming care legal landscape. “We’re asking ourselves what this means for our state,” he says. “Are there programs available in our state that might be able to assist families who aren’t moving to Michigan but would be willing to travel out of state to obtain gender-affirming care for their children?”

Until a more formalized network of resources is established in Michigan, parents of trans kids will need to continue building the kind of ad hoc approach that’s become the norm in the current era. Parents will continue relying on word-of-mouth recommendations in Facebook groups, scouring the internet for clinics and programs accepting out-of-state patients (especially those that accept out-of-state insurance policies), and just leaning on one another at a time when their children are being targeted by powerful governmental bodies. “It’s exhausting,” writes a parent from Toledo on a private Facebook group for Ohio parents of trans teens. “And we have resources. What would happen if we didn’t?”

Kaplan notes that gender-affirming healthcare for minors is only in question because of the political nature of the issue. “It’s politics at its most cynical,” he says. “They don’t give a damn about the welfare of these kids. If they did, they’d rely on what experts say and know that it’s not just a child saying, ‘I’m trans and I want to be on hormones.’ It doesn’t work that way. Certain criteria must be met, and it’s based on medical professional judgment and, of course, the consent of that child’s parents.”

Facts and real information are not the motivating factors for politicians attacking gender-affirming care across the country, Kaplan notes. Using transgender issues as wedge issues help far-right politicians fundraise from their base of voters.

One potential legally gray area is transferring care from a state like Ohio to a Michigan provider. Once the dust settles in Ohio, there could be a restriction on what information an Ohio provider could grant to a Michigan provider, for example. “The family would need to request a copy of their medical records and they, themselves, would bring those medical records to Michigan,” Kaplan says. Restrictions on telemedicine could also be impacted — ultimately, families may need to travel to the state regularly for the typical gender-affirming care protocol, which involves ongoing bloodwork, evaluations and assessments by multiple medical professionals.

While multiple organizations throughout Michigan already help patients from out of state, it’s not necessarily something they advertise widely to protect patient safety or, perhaps, to stay out of the line of sight of far-right operatives. For now, Kaplan suggests out-of-state parents reach out to Michigan organizations individually.

Several organizations, including the Michigan ACLU, are working together to identify resources to help out-of-state patients access gender-affirming care, Kaplan says. As they iron out a list of those resources and identify potential funding solutions, the information will be made public. In the meantime, reaching out to individual organizations is the quickest way for families to access the care they need in Michigan. The ACLU, for example, can answer legal questions, and Planned Parenthood of Michigan (PPMI) can answer specifics about accessing care in the state (though the organization does not prescribe hormonal treatments to minors).

Ashlea Phenicie, PPMI chief advocacy officer, tells Pride Source the organization is deeply concerned about the growing number of political attacks seeking to criminalize health care, trans people and providers. “No one should have to leave their state to access medical care,” she says. The organization serves as an access point for patients traveling from hostile states. “We are confident in our ability to provide gender-affirming care in Michigan’s current legal landscape. However, we know that some politicians would seek to ban this essential health care and are committed to fiercely defending the rights of all people to access care without political interference.”

“It’s heartbreaking, and then it makes you mad,” Kaplan says. “It’s the cruelty. I find it quite cruel, this attack on probably the most vulnerable members of the LGBTQ+ community, transgender young people. It’s a sad chapter in the history of the LGBTQ+ rights movement that yes, we will get through, but right now, harm is being done. For Michigan to just rest on our laurels and not think of ways we can be helpful in this situation would go against probably all our values and all that we believe in. So it’s important that we do something.”