Missouri Top Court Silent on Constitutionality of Trans Care Ban

The Missouri Supreme Court gave no clue Wednesday as to whether it intends to uphold a law that bans gender-affirming care for minors and prohibits the state’s Medicaid program from paying for it for anyone.

The judges remained silent throughout oral arguments except for a brief question about how a recent Eighth Circuit case might affect their decision.

About half the states now ban gender-affirming care for youths amid a Trump administration push to do away with it altogether.

Brandt v. Griffin is distinguishable from this case, as is the US Supreme Court’s recent decision in United States v. Skrmetti, Nora Huppert, of Lambda Legal Defense & Education Fund Inc., told the judges. The courts there said Arkansas’ and Tennessee’s bans on gender-affirming care for minors didn’t violate the US Constitution’s 14th Amendment equal protection clause.

But those laws are narrower than Missouri’s, Huppert said. And the US Supreme Court found the laws treated people differently based on the medical care they seek, not on their sex or transgender status. Missouri’s law was part of a package of provisions specifically aimed at transgender people, including a sports participation ban, she said.

This case, moreover, alleged the provision violates the Missouri Constitution, which provides greater protection for the state’s citizens than does the federal Constitution, which was at issue in the two cited cases. The state document also gives provides a fundamental right of autonomy with respect to one’s health and welfare that extends to minors and gives parents a right to make medical decisions on behalf of their children, she said.

Louis Capozzi, of the Missouri Attorney General’s Office, said the judges should follow Brandt and Skrmetti. The Arkansas and Tennessee laws are identical to Missouri’s in all relevant respects, and there’s no authority for the proposition that Missouri’s equal protection guarantees are stronger than those found in the US Constitution, he said.

The trial court used the correct standard of review when analyzing the statute, he also said. The provision was rationally related to the state’s legitimate interest in protecting children from unproven medical treatments. Lawmakers have “wide discretion” when adopting legislation to protect citizens’ health and welfare, Capozzi said.

The attorneys touched briefly on the Medicaid provision, with Capozzi saying the trial court correctly said the plaintiffs had waived it. Huppert said that wasn’t true—that their arguments to preserve the payments were woven throughout the plaintiffs’ briefs.

Transgender minors, their parents, caregivers, and national transgender advocacy groups sued the state in 2023, alleging the ban on gender-affirming care violated the Missouri Constitution. A trial judge rejected their claims, and the law took effect Aug. 28, 2023, after a different trial judge denied a preliminary injunction.

Chief Justice Mary R. Russell and Judges Kelly C. Broniec, Zel M. Fischer, Ginger K. Gooch, W. Brent Powell, Robin Ransom, and Paul C. Wilson heard the arguments.

ACLU of Missouri Foundation and Bryan Cave Leighton Paisner LLP also represent the plaintiffs.

The case is E.N. v. Kehoe, Mo., No. SC100933, oral arguments 9/24/25.