Unprecedented Attack On Trans Medical Access: HB 668 Fact Sheet

It is important to note that HB 668 does not make gender-affirming medical illegal for trans adults or youth. HB 668 also does not restrict access to, or insurance coverage for, mental health care for trans adults or youth. However, HB 668 does limit access to gender-affirming medical care in a variety of ways that greatly restricts access to such care for many Idahoans.  

HB 668’s broad funding restrictions could prohibit access to evidence-based medical treatment. Advocates are currently investigating to what extent the bill would affect public employees and public university students. What we know currently is that the restrictions would:  

• First, the bill would ban health care professionals that work for local, county, or state agencies from providing gender-affirming medical treatment. State agencies include the Idaho Department of Health and Welfare, Boise State University, the Health Insurance Exchange, the Pharmacy Board, and more.  
• Second, the bill would bar Idaho Medicaid from covering the cost of gender-affirming medical care.  
• Third, the bill would ban any gender-affirming health care on state property or facilities. State facilities include state-owned prisons, public colleges, and hospitals around the state. 

HB 668 is a sweeping assault on access to medical treatment for transgender people.  

• Gender-affirming health care is medically necessary, standard treatment; as the American Medical Association has explained, “Gender-affirming care is medically necessary, evidence-based care that improves the physical and mental health of transgender and gender-diverse people.”   
• The bill categorically bans Medicaid coverage for gender-affirming medical treatment, singling out low-income Idahoans for significant harm. The impact of these restrictions will be far-reaching and devastating. 

HB 668 would deny trans Idahoans — and only trans Idahoans — certain medically necessary procedures and treatments. If passed, HB 668 would prohibit some health care (hormone replacement, puberty blockers, etc.) in some instances (when funded by Medicaid, performed at a state-funded hospital, or administered by a government employee) for transgender people. Because the very same treatments would still be available for people who are not transgender, HB 668 discriminates against transgender people. Singling out treatment for only some people because they are transgender is discriminatory and against the law.    

• HB 668 singles out treatment if and only if it “alter[s] the appearance of an individual in order to affirm the individual’s perception of the individual’s sex in a way that is inconsistent with the individual's biological sex.” That means trans folks would be excluded from medical care that’s available to everyone else – and, importantly, trans folks would be excluded from such care simply because they are transgender.  
• Federal law like the Affordable Care Act (ACA) prohibits discrimination based on transgender status; Section 1557 of the ACA says health facilities, programs, and activities receiving federal funding can’t deny insurance coverage or care based on sex and gender identity.  
• Federal nondiscrimination rules say no one can be denied sex-specific care because someone identifies as transgender. It's against the law, for example, to deny a trans man treatment for ovarian cancer if such care is medically necessary.  
• HB 668 says certain treatments are not allowed when they’re used to affirm a transgender person’s gender. Denying gender-affirming medical care to transgender people that is available for cisgender people is discriminatory and against the law.  

Idaho has already faced legal challenges because of discriminatory bans on gender-affirming health care.    

• In 2017, Adree Edmo, an incarcerated trans woman sued the Idaho Department of Correction because she was denied medically necessary health care. A district court judge ruled in favor of Ms. Edmo; IDOC was ordered to provide Ms. Edmo the medical treatment she needed – and to pay Ms. Edmo more than $2.5 million in fees and other legal expenses.  
•  In 2022, the Idaho Department of Health and Welfare was sued for denying medically necessary health care to two transgender Idahoans. That lawsuit is ongoing. A federal court held that Idaho’s most recent attempt to ban gender affirming medical care, 2023’s HB 71, would likely not survive constitutional scrutiny. The court enjoined the law in its entirety. However, this injunction is currently limited to only the plaintiffs named in the lawsuit due to a recent ruling from the U.S. Supreme Court. 
• HB 668 is also likely to be challenged in court; it clearly violates federal and state Medicaid guidelines. These violations could cost Idaho greatly in litigation costs.  

HB 668 likely violates multiple federal laws, including the ACA (see above) and the Medicaid Act. By violating federal law and rules, HB 668 poses a serious threat to Medicaid funding in our state.   

• Prior to HB 668, Idaho had no explicit policy that denied gender-affirming medical care for those enrolled in Medicaid.  
• HB 668 violates federal Medicaid rules – and the Idaho Medicaid rules that follow federal guidelines. If HB 668 passes, and Idaho is found in violation of Medicaid rules, it’s possible the state could lose federal Medicaid support. That means the state is risking the health care of nearly 450,000 Idahoans enrolled in Medicaid. 
• The bill violates federal Medicaid regulations: Medicaid services must be available for any medically necessary health care, diagnostic treatment or services, and other health care in a person’s individual treatment plan. Every major medical association – and Medicaid itself – agree that gender affirming health care is medically necessary.  
• The bill violates Idaho Medicaid rules: all medically necessary health care services must be available for people enrolled in Medicaid.  
• HB 668 would limit access to scientifically vetted, standard, life-saving medical treatment. 

Parents of transgender youth have the same rights as all other parents. Parents of trans kids in Idaho need to have the continued freedom to make responsible health care decisions for their children. Because of restrictions on providers, facilities, and insurance coverage, HB 668 unfairly burdens parents in exercising these fundamental rights 

• Any parent whose child is in need has the right to seek expert medical advice. Parents and health care providers need to have the continued right to act on that advice if it will enable their child to thrive. While HB 668 does not make gender-affirming medical care illegal for trans youth, it places an unequal burden on parents of trans kids in securing the necessary medical care for their children.  
• Evidence-based medical care for transgender adolescents has been available for more than 20 years. The same medications prescribed for transgender youth have been prescribed for non-transgender youth for a variety of other medical conditions for even longer — more than 40 years. There is a substantial body of medical research demonstrating that these medications are safe and effective.