2025–2026
Many states banned or limited sex-rejecting procedures for minors, the Supreme Court said those state bans may stand, and a federal Medicaid rule cuts funding for those procedures on minors.
Federal actions
What the law allows
States and D.C. — 50 states plus D.C.
- Medical · Ban · 22
- Medical · Restriction · 3
- Medical · Litigation-setback · 2
- Medical · Proposed bill · 3
- Medical · No ban · 21
- Schools · Schools ban · 2
- Schools · Schools restriction · 6
- Schools · Schools mixed · 1
click a state for more details.
- BanStatute in force.
- RestrictionNarrower than a total ban.
- Litigation-setbackBan or limit was enacted, then a court blocked it. The statute is on the books; it is not enforced.
- Proposed billA bill has been introduced. It is not law yet.
- No banNo statewide medical ban. Shield laws, if any, are in the state summary.
Jump to a state
One A–Z grid: all 50 states and D.C. Color is medical status. Full sourced cards are on the hub.
Alabama has banned puberty blockers, cross-sex hormones, and surgeries for minors.
Alabama AL
Schools: HB322 (2022) limits classroom instruction on sexual orientation or gender identity in K–5 and requires multiple-occupancy restrooms and changing areas by biological sex. Separate from the medical ban.
No state law restricts puberty blockers, cross-sex hormones or surgery for minors. Alaska has no statewide ban and no statewide shield law.
Alaska AK
Official sources
Arizona banned surgeries on minors, but not puberty blockers or cross-sex hormones. As of 13 October 2026, AHCCCS no longer covers puberty blockers or cross-sex hormones for gender dysphoria in patients under 19 and denies them as a benefit exclusion. Patients who started them on or before that date are grandfathered for six months.
Arizona AZ
Arkansas banned puberty blockers, cross-sex hormones, and surgeries for minors. A court paused it; a higher court put the ban back in force.
Arkansas AR
Official sources
California has no statewide ban. California also has a shield law. From 13 Oct 2026, California pays for puberty blockers, cross-sex hormones and surgeries for minors with state-only money.
California CA
Plaintiff in the 2 September 2026 CMS funding suit.
Official sources
No state law restricts puberty blockers, cross-sex hormones or surgery for minors. On 18 May 2026 the Colorado Supreme Court ordered Children’s Hospital Colorado to restore puberty blockers and cross-sex hormones for minors while Boe v. Children’s Hospital Colorado proceeds. Colorado also has a shield law. Colorado suspended Medicaid coverage of puberty blockers, cross-sex hormones and surgeries for minors on 13 Oct 2026 until lawmakers act.
Colorado CO
Plaintiff in the 2 September 2026 CMS funding suit.
Connecticut’s Medicaid program (HUSKY) covers gender-transition services, including for children. Connecticut also has a shield law.
Connecticut CT
Plaintiff in the 2 September 2026 CMS funding suit.
No state law restricts puberty blockers, cross-sex hormones or surgery for minors. HB 346 (2024) never became law. There is no verified shield statute. Gov. Matt Meyer's office said Delaware will replace the lost federal funding in full for puberty blockers, cross-sex hormones and surgeries on minors.
Delaware DE
Plaintiff in the 2 September 2026 CMS funding suit.
Official sources
D.C. is not a state. No law restricts puberty blockers, cross-sex hormones or surgery for minors. Local rules work like a shield law.
District of Columbia DC
Plaintiff in the 2 September 2026 CMS funding suit.
Official sources
Florida has banned puberty blockers, cross-sex hormones, and surgeries for minors.
Florida FL
Schools: Florida law restricts classroom instruction on gender identity and sexual orientation. HB 1557 barred it in K–3; HB 1069 extended the statute through grade 8. Board Rule 6A-10.081 goes further: educators shall not intentionally provide that instruction in preK–grade 8 (narrow exceptions), and in grades 9–12 unless it is required by state academic standards or is part of reproductive health with a parent’s written consent. That is a near K–12 classroom bar via the board rule, not a Texas-style zero-exception PreK–12 statute.
Georgia banned cross-sex hormones and surgeries for minors, but not puberty blockers. HB 54, which would have banned puberty blockers, died.
Georgia GA
Hawaii has no statewide ban. Act 059 (HB 1875), effective 1 July 2026, is a shield law.
Hawaii HI
Plaintiff in the 2 September 2026 CMS funding suit.
Idaho has banned puberty blockers, cross-sex hormones, and surgeries for minors.
Idaho ID
Official sources
Illinois has no statewide ban. Illinois also has a shield law. Illinois pays for puberty blockers, cross-sex hormones and surgeries for minors with state-only money through 30 June 2027.
Illinois IL
Plaintiff in the 2 September 2026 CMS funding suit.
Official sources
Indiana has banned puberty blockers, cross-sex hormones, and surgeries for minors.
Indiana IN
Schools: HEA 1608 (2023): no human-sexuality instruction before grade 4; schools must notify a parent within five business days if an unemancipated student asks to change name or pronouns.
Iowa has banned puberty blockers, cross-sex hormones, and surgeries for minors.
Iowa IA
Schools: SF496 (2023) barred K–6 gender-identity and sexual-orientation instruction and added parental-notification rules. A federal district order in May 2025 narrowed “program/promotion” language and most notification text; the K–6 mandatory-instruction bar still stands. Written rule, court narrowing — Schools mixed.
Official sources
Kansas passed a ban. A court blocked it. The statute is on the books; it is not enforced.
Kansas KS
Official sources
Kentucky has banned puberty blockers, cross-sex hormones, and surgeries for minors.
Kentucky KY
Schools: The same SB150 also rewrote KRS 158.1415: no human-sexuality instruction in grade 5 and below; no instruction whose purpose is exploring gender identity, gender expression, or sexual orientation; parental consent from grade 6.
Louisiana has banned puberty blockers, cross-sex hormones, and surgeries for minors.
Louisiana LA
Official sources
Maine has no statewide ban. Maine also has a shield law. From 13 Oct 2026, Maine pays for puberty blockers, cross-sex hormones and surgeries for minors with state-only money.
Maine ME
Plaintiff in the 2 September 2026 CMS funding suit.
Official sources
Maryland has no statewide ban. Chapter 253 (HB 283, 2023) is a Medicaid coverage law, not a shield statute. From 13 Oct 2026, Maryland pays for puberty blockers, cross-sex hormones and surgeries for minors with state dollars.
Maryland MD
Plaintiff in the 2 September 2026 CMS funding suit.
Official sources
Massachusetts has no statewide ban. Massachusetts also has a shield law. From 13 Oct 2026, Massachusetts pays for puberty blockers, cross-sex hormones and surgeries for minors with state money.
Massachusetts MA
Plaintiff in the 2 September 2026 CMS funding suit.
Official sources
HB 4467 would ban puberty blockers, cross-sex hormones, and surgeries for minors. It is not law yet.
Michigan MI
Plaintiff in the 2 September 2026 CMS funding suit.
Minnesota has no statewide ban. Minnesota also has a shield law.
Minnesota MN
Plaintiff in the 2 September 2026 CMS funding suit.
Official sources
Mississippi has banned puberty blockers, cross-sex hormones, and surgeries for minors.
Mississippi MS
Official sources
Missouri has banned puberty blockers, cross-sex hormones, and surgeries for minors. The Missouri Supreme Court upheld the ban on 13 January 2026.
Missouri MO
Montana passed a ban. Courts blocked it. The statute is on the books; it is not enforced. From 13 Oct 2026, Montana Medicaid no longer pays for puberty blockers, cross-sex hormones or surgery for minors, with a taper of cross-sex hormones until 13 Apr 2027.
Montana MT
Official sources
Nebraska bans gender surgeries under 19. New puberty blockers and cross-sex hormones require a pattern that began or worsened at puberty, at least 40 hours of gender-identity therapy, informed consent, and a 7-day wait; courses started before Oct 1, 2023 may continue.
Nebraska NE
No state law restricts puberty blockers, cross-sex hormones or surgery for minors. A 2023 shield bill was vetoed, so Nevada is not a shield state.
Nevada NV
Plaintiff in the 2 September 2026 CMS funding suit.
Official sources
HB 377 (Chapter 275, 2025) bans puberty blockers and cross-sex hormones for minors from 1 January 2026. HB 619 (2024) bans surgery. In force.
New Hampshire NH
A1847 would ban puberty blockers, cross-sex hormones, and surgeries for people under 21. It is not law yet. New Jersey also has a shield law.
New Jersey NJ
Plaintiff in the 2 September 2026 CMS funding suit.
New Mexico has no statewide ban. New Mexico also has a shield law. From 13 Oct 2026, New Mexico pays with state money for puberty blockers and cross-sex hormones for ages 12 to 17. Surgery for minors is not covered.
New Mexico NM
Official sources
From 13 Oct 2026, New York covers puberty blockers, cross-sex hormones and surgeries for minors with state-only money. New York also has a shield law.
New York NY
Plaintiff in the 2 September 2026 CMS funding suit.
North Carolina has banned puberty blockers, cross-sex hormones, and surgeries for minors.
North Carolina NC
Schools: SL 2023-106 (SB 49), Parents’ Bill of Rights: no gender-identity, sexual-activity, or sexuality curriculum in K–4, except answers to student-initiated questions.
North Dakota has banned puberty blockers, cross-sex hormones, and surgeries for minors. The North Dakota Supreme Court upheld the ban on 17 September 2026.
North Dakota ND
Ohio has banned puberty blockers and cross-sex hormones for minors. The ban stays in force while the Ohio Supreme Court decides Moe v. Yost (argued 24 March 2026).
Ohio OH
Schools: HB8 (Parents’ Bill of Rights, effective 2025): parental notice and opt-out for “sexuality content,” including gender ideology, and notice if a student asks to identify as a gender different from biological sex.
Oklahoma has banned puberty blockers, cross-sex hormones, and surgeries for minors.
Oklahoma OK
Official sources
Oregon has no statewide ban. Oregon also has a shield law. From 13 Oct 2026, Oregon pays for puberty blockers, cross-sex hormones and surgeries for minors with state money.
Oregon OR
Plaintiff in the 2 September 2026 CMS funding suit.
Official sources
HB 1033 would ban puberty blockers, cross-sex hormones, and surgeries for minors. It is not law yet. There is no statewide shield law. Pennsylvania will use state dollars to keep covering puberty blockers and cross-sex hormones for minors on Medicaid. Gov. Shapiro's office said state law bars state money for CHIP.
Pennsylvania PA
Plaintiff in the 2 September 2026 CMS funding suit.
Rhode Island has no statewide ban. Rhode Island also has a shield law.
Rhode Island RI
Plaintiff in the 2 September 2026 CMS funding suit.
Official sources
South Carolina has banned puberty blockers, cross-sex hormones, and surgeries for minors.
South Carolina SC
Official sources
South Dakota has banned puberty blockers, cross-sex hormones, and surgeries for minors.
South Dakota SD
Official sources
Tennessee has banned puberty blockers, cross-sex hormones, and surgeries for minors. The Supreme Court said that ban may stand.
Tennessee TN
Schools: Tenn. Code §49-6-1308 (SB1443 / Public Chapter 353, 2023): 30-day notice and written parental opt-in before sexual-orientation or gender-identity curriculum. Separate from the medical ban (SB1 / Skrmetti).
Texas has banned puberty blockers, cross-sex hormones, and surgeries for minors. The Texas Supreme Court upheld SB 14 on 28 June 2024.
Texas TX
Schools: SB12 (89th, effective 2025–26) added Education Code §28.0043: no PreK–12 instruction, guidance, activities, or programming regarding sexual orientation or gender identity. Separate from the medical ban (SB14).
SB 16 (2023) banned new puberty blockers, cross-sex hormones and surgery for minors. HB 174 (signed 18 March 2026) makes the cross-sex hormone ban permanent, with limited continuation for some patients already on cross-sex hormones.
Utah UT
Vermont has no statewide ban. Vermont also has a shield law. From 13 Oct 2026, Vermont pays for puberty blockers, cross-sex hormones and surgeries for minors with state money.
Vermont VT
Plaintiff in the 2 September 2026 CMS funding suit.
Official sources
As of 13 October 2026, Virginia Medicaid no longer pays for puberty blockers, cross-sex hormones, or surgeries for members under 18, and CHIP no longer pays for them for members under 19. Youth already on cross-sex hormones may taper for up to six months; puberty blockers and surgeries get no taper. Mental health counseling stays covered. There is no statewide shield law.
Virginia VA
Plaintiff in the 2 September 2026 CMS funding suit.
Washington has no statewide ban. Washington also has a shield law. From 13 Oct 2026, Washington pays for puberty blockers, cross-sex hormones and surgeries for minors with state-only money.
Washington WA
Plaintiff in the 2 September 2026 CMS funding suit.
Official sources
West Virginia has banned puberty blockers, cross-sex hormones, and surgeries for minors.
West Virginia WV
Official sources
No state law restricts puberty blockers, cross-sex hormones or surgery for minors. Wisconsin has no statewide ban and no statewide shield law.
Wisconsin WI
Plaintiff in the 2 September 2026 CMS funding suit.
Official sources
Wyoming has banned puberty blockers, cross-sex hormones, and surgeries for minors.
Wyoming WY
Official sources
Federal record
There is no nationwide ban. The country is split. The Supreme Court said states may protect children. Twenty-two states have a ban in force. Three have a narrower restriction. Two have a statute a court blocked. The rest have no statewide medical ban.
Supreme Court. On 18 June 2025, United States v. Skrmetti, 6–3. The Court upheld Tennessee’s ban on puberty blockers, cross-sex hormones, and surgeries for minors. Official opinion (PDF). That is the green light for states.
The evidence. HHS published Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices. Weak evidence. Inadequate informed consent. No reliable proof these drugs and surgeries fix mental health. Official HHS review.
The money — FINAL. CMS published the final Medicaid and CHIP (Children’s Health Insurance Program) rule ending federal funding for what HHS calls “sex-rejecting procedures” on children — puberty blockers, cross-sex hormones, and surgeries. Effective 13 October 2026. Federal Register. This is a Medicaid and CHIP funding cutoff.
DOJ hospital deals. Texas Children’s, Cleveland Clinic, Connecticut Children’s, Mount Sinai and others signed resolutions to stop the procedures on minors. DOJ’s own releases say the claims resolved are allegations only, there has been no determination of liability, and the hospitals denied the allegations.
The states — medical. The hub lists all 50 states and D.C. Ban means an enacted medical prohibition is in force — 22 states, including Arkansas after the Eighth Circuit reversed the district-court stay. Three limits are restrictions, not full bans: Arizona (surgery ban only; from 13 October 2026 Medicaid no longer pays for puberty blockers or cross-sex hormones under 19), Georgia (hormones and surgeries, not puberty blockers; HB 54 died), Nebraska (surgeries banned under 19; new blockers and hormones require 40 hours of therapy, consent, and a 7-day wait). Litigation-setback is Kansas and Montana — statutes on the books, courts blocking them today. No strikethrough. No ban is the rest: no statewide medical ban. Clinic facts sit on the state card when a named source documents them. Some of those states also have a shield law — it protects access, blocks out-of-state interference, and shields providers and patients. The map and badge still say No ban. California, Oregon, New Jersey, and Washington are No ban with official shield statutes. They are not omitted, and they are not Ban.
The states — schools. Curriculum and parental-rights laws sit on a second badge on the states that have one. Listed with an official URL: Florida HB 1069 (statute through grade 8; lineage from HB 1557) and Board of Education Rule 6A-10.081 (Principles of Professional Conduct — near K–12 classroom bar, with limited 9–12 exceptions); Texas SB12 (89R) / Education Code §28.0043; Tennessee §49-6-1308 (SB1443 / Public Chapter 353 — parental opt-in for sexual-orientation or gender-identity curriculum); Alabama HB322; Indiana HB 1608; Kentucky SB150 school sections; North Carolina SL 2023-106; Ohio HB8; Iowa SF496, later narrowed in federal court — Schools mixed.
Twenty-one states, Pennsylvania’s governor, and D.C. sued on 2 September 2026 to keep Medicaid and CHIP paying. That suit has not blocked the final rule.
Puerto Rico — territory. Ley 63-2025 (16 July 2025) forbids puberty blockers, cross-sex hormones, and surgeries to treat gender dysphoria in anyone under 21. That card sits in the Americas.
Skrmetti plus a funding cutoff is how you starve a medical scandal without pretending Congress already banned it everywhere.