Medical exiles: Families flee states amid crackdown on transgender care

Hal Dempsey wanted to escape from Missouri. Arlo Dennis is fleeing Florida. The Tillison family cannot stay in Texas.

They are part of a new migration of Americans who are uprooting their lives in response to a series of laws across the country restricting healthcare for transgender people.

Missouri, Florida, and Texas are among at least 20 states that have limited components of gender-affirming health care for trans youth. These three states are also among the states preventing Medicaid, the public health insurance for low-income people, from paying for key aspects of that care for patients of all ages.

More than a quarter of trans adults surveyed by KFF and The Washington Post late last year said they’ve moved to another neighborhood, city or state to find greater acceptance. Now, new restrictions on healthcare and the possibility of more in the future provide further motivation.

Many are heading to places that are passing laws to support care for trans people, making those states attractive sanctuaries. California, for example, passed legislation last fall to protect those who receive or provide gender-affirming care from prosecution. And now, California providers are receiving more calls from people looking to relocate there to avoid interruptions in their care, said Scott Nass, a family physician and transgender care expert based in the state.

But the influx of patients presents a challenge, Nass said, because the existing system can’t handle all the refugees potentially out there.

In Florida, the legislative focus on trans people and their health care has convinced Arlo Dennis, 35, that it’s time to uproot their family of five from the Orlando area, where they’ve lived for more than a decade . They plan to move to Maryland.

Dennis, who uses their pronouns, no longer has access to HRT after Florida’s Medicaid program stopped covering transition-related care in late August with claims that the treatments are experimental and lack evidence of effectiveness. Dennis said they ran out of meds in January.

It definitely led to my mental health struggling and my physical health struggling,” Dennis said.

Moving to Maryland will require resources that Dennis said their family doesn’t have. They launched a GoFundMe campaign in April and raised more than $5,600, most of it from strangers, Dennis said. Now the family, which includes three adults and two children, plans to leave Florida in July. The decision wasn’t easy, Dennis said, but they felt they had no choice.

I’m fine if my neighbor disagrees with how I’m living my life, Dennis said. But this was literally banning my existence and making my access to health care impossible.

Mitch and Tiffany Tillison decided they needed to leave Texas after state Republicans made anti-trans youth policies the focus of their legislative agenda. Their 12-year-old came out as trans about two years ago. They asked to publish only her middle name, Rebecca, because they fear for her safety due to threats of violence against trans people.

This year, the Texas Legislature passed legislation limiting gender-affirming health care for young people under 18. It specifically bans physical assistance, but local LGBTQ+ advocates say recent crackdowns have also had a chilling effect on the availability of mental health therapy for trans people.

While the Tillisons declined to specify what treatment, if any, their daughter is receiving, they said they reserve the right, like her parents, to provide the care their daughter needs, and that Texas has taken away this right. This, in addition to growing threats of violence in their community, particularly in the wake of the May 6 mass shooting by an outspoken neo-Nazi at Allen Premium Outlets, about 20 miles from their home in suburban Dallas, has prompted the family to decide to move to Washington state.

I kept her safe, Tiffany Tillison said, adding that she often thinks back to the moment her daughter walked out on her on a long drive home after a one-day soccer tournament. It’s my job to continue to keep her safe. My love is infinite, unconditional.

For her part, Rebecca is being pragmatic about her July move: it’s sad, but it’s what we have to do, she said.

A close call to the loss of key medical care in Missouri also prompted some trans people to rethink life there. In April, Missouri Attorney General Andrew Bailey issued an emergency rule aimed at limiting access to transition-related surgery and cross-sex hormones for all ages and limiting puberty-blocking drugs, which suspend puberty but they do not alter gender characteristics. The next day, Dempsey, 24, who uses they/them pronouns, launched a GoFundMe fundraiser for himself and their two partners to leave Springfield, Missouri.

We are three trans individuals who are all dependent on HRT and soon to be prohibitively restricted gender-affirming treatments, Dempsey wrote in the fundraiser appeal, adding that they wanted to escape Missouri when our lease expires. at the end of May.

Dempsey said they also received a prescription for a three-month supply of hormone therapy from their doctor in Springfield to help them through the move.

Bailey withdrew from his government after the state legislature in May restricted new access to such treatments for minors, but not for adults like Dempsey and their partners. However, Dempsey said their future in Missouri didn’t look promising.

Neighboring Illinois was an obvious place to move; The legislature passed a law in January that requires state-regulated insurance plans to cover gender-affirming health care at no extra cost. Where exactly was a bigger question. Chicago and its suburbs seemed too expensive. The partners wanted a progressive community similar in size and cost of living to the city they were leaving. They were looking for a Springfield in Illinois.

But not Springfield, Illinois, Dempsey joked.

Gwen Schwarz planned to stay in her hometown of Springfield, Missouri before anti-trans legislation in the state moves forward this year. She wanted to apply for a graduate program and have transition surgery. But her plans have changed and she now intends to move to Nevada.(Bruce E. Stidham for KFF Health News)

Gwendolyn Schwarz, 23, had also hoped to stay in her hometown of Springfield, Missouri, where she recently graduated from Missouri State University with a degree in film and media studies. She had planned to continue her education in a graduate program at the university and, within the next year, have transition-related surgery, which can take a few months to recover.

But his plans changed when Bailey’s government sparked fear and confusion.

I don’t want to be stuck and temporarily disabled in a state that doesn’t see my humanity, Schwarz said.

She and a group of friends are planning to move west to Nevada, where state lawmakers have passed a measure requiring Medicaid to cover gender-affirming treatment for trans patients.

Schwarz said she hopes that moving from Missouri to the Nevada capital, Carson City, will allow her to continue living her fearless life and eventually get the surgery she wants.

Dempsey and their partners settled on Moline, Illinois as a place to relocate. All three had to quit their jobs to move, but they raised $3,000 on GoFundMe, more than enough to put down a deposit on an apartment.

On May 31, the partners packed up the things they hadn’t sold and made the 400-mile journey to their new home.

Since then, Dempsey has already been able to see a doctor at a Moline clinic that caters to the LGBTQ+ community and received a new prescription for hormone therapy.

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