Rep. David Hale amended his bill to ban Kentucky Medicaid from paying for some gender-affirming care. (Kentucky Lantern photo by Liam Niemeyer)
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An advancing bill seeking to cancel Democratic Gov. Andy Beshear’s restrictions on conversion therapy would now also prohibit Medicaid from paying for some forms of gender-affirming medical care.
A lobbyist for a conservative policy group argued the additions to House Bill 495 were to ensure the government isn’t paying for elective care for transgender people. A coalition of advocates representing the LGBTQ community and professional associations for social workers and psychologists denounced the additions as attacks on health care for transgender Kentuckians.
HB 495 sponsor Rep. David Hale, R-Wellington, agreed to changes in the bill by the Senate Health Services Committee that restrict the Department for Medicaid Services and Medicaid managed care organizations from issuing payments for:
- Cross-sex hormones in amounts greater than would normally be produced endogenously in a healthy person of the same age and sex.
- Gender reassignment surgery to alter or remove physical or anatomical characteristics or features that are typical for and characteristic of a person’s biological sex.
Almost 1 in 3 Kentuckians are covered by the federal-state Medicaid program.
The bill’s original provisions remained in the legislation, seeking to cancel an executive order issued by Beshear last year restricting the controversial practice of conversion therapy. Hale on the House floor had previously said he believed Beshear’s executive order infringed on the First Amendment rights of parents to seek whatever therapy they felt appropriate for their children.
The amended HB 495 advanced from the Senate committee by a 6-3 vote with Sen. Danny Carroll, R-Paducah, joining the two Democrats on the committee in opposition. The amended bill still needs passage by the Senate. The House would need to concur with the changes before it would be sent to Beshear’s desk for his consideration.
Hale didn’t address the additions in the bill in testimony before the committee. Nick Spencer, the director of policy at the conservative group The Family Foundation, told lawmakers when asked about the provisions that “the government has no business spending tax dollars on elective surgeries and elective procedures for people with transgender feelings.”
“There are many medical procedures that the government does not cover, and the government has no business covering those services,” Spencer said. “Now, if someone who is an adult wants to pursue that course of treatment on their own dime, I would disagree with that course of action, but that is their right to do so.”
Advocates denounce additions to bill
A coalition of advocates representing the Kentucky Psychological Association, the Kentucky chapter of the National Association of Social Workers and the LGBTQ rights advocacy group The Fairness Campaign all spoke strongly against the new provisions in the bill. The groups were also opposed to the original version of HB 495, a bill that’s changed twice moving through the legislature.
“Language is being inserted into this bill denying health care to transgender people. It’s hard for me to put into words how much access to hormone therapy has helped me,” said Serenity Johnson, a transgender Kentuckian living in Hardin County.
Johnson said the prohibition on Medicaid paying gender-affirming hormonal therapy or surgery wouldn’t directly impact her because she has insurance through her employment. But for Kentuckians with Medicaid seeking such treatment, she said, refusing them “necessary health care” is a “cruel denial.”
Chris Hartman, the executive director of the Fairness Campaign, condemned the additions to the bill as a “sneak attack on our transgender community.”
Sen. Stephen Meredith, R-Leitchfield, at one point during Hartman’s testimony threatened to have Hartman removed from the testimony table for “inflammatory remarks” directed at the committee.
“This is a disrespectful subversion of the legislative process,” Hartman said. “You will cost lives.”
Gender-affirming care covered by Medicaid varies from state to state, according to a survey published in 2022 by the health policy nonprofit Kaiser Family Foundation.
A Cabinet for Health and Family Services spokesperson Kendra Steele in an email said Kentucky Medicaid covers services that are deemed “medically necessary” for a person by a provider unless specifically prohibited by law. Steele referenced current state law that bans gender-affirming care for minors.
‘Very, very, dangerous’
Other advocates spoke out against other provisions of HB 495 seeking to cancel Beshear’s executive order restricting conversion therapy. Conversion therapy attempts to alter a young person’s gender expression or sexual attractions.
The American Academy of Child and Adolescent Psychiatry (AACAP) is among the medical and psychological organizations that have condemned conversion therapy. AACAP has stated conversion therapies “lack scientific credibility and clinical utility” and that there is “evidence that such interventions are harmful.”
The American Psychological Association has stated people who have undergone “sexual orientation change efforts” are significantly more likely to be depressed and suicidal. The National Suicide Prevention Lifeline is 988.
Former Republican State Sen. Alice Forgy Kerr told lawmakers she considered conversion therapy to be not only ineffective but “very, very dangerous.” She spoke to lawmakers while her son, who she said was gay, sat in the audience.
“That’s not just my opinion as a mother. That’s the overwhelming consensus of medical experts, mental health professionals and those who have survived the trauma of conversion therapy — or torture, as I call it. The science is clear,” Kerr said.
Spencer, the policy director for the conservative group, told lawmakers counselors who physically abuse or expose sexually explicit material to minors should be held accountable. But he considered talk therapy to be “morally permissible.”
“From my perspective, those who counsel against homosexual and transgender feelings are expressing love for an individual,” Spencer said.
Democrats on the committee in voting against the legislation echoed concerns from the groups who spoke against the bill.
Berg, speaking to Hale, said she appreciated the lengths the bill sponsor has gone to work on the original provisions of the bill. But she took issue with the new additions.
“You added the second part of this bill where literally adults who know who they are, whose medical treatment — contrary to your lobbyist back there — almost exclusively, is either a shot or a pill, and we’re going to deny them that,” Berg said.