gender reassignment surgery laws in oregon

Gender Spender

Kim lacapria, published july 10, 2015.

FACT CHECK:   Does Oregon now allow young teenagers to obtain gender reassignment (sex change) surgery without the knowledge or consent of their parents?

Claim:     Oregon quietly enacted a taxpayer-funded policy that allows minors as young as 15 to undergo gender reassignment surgery without the knowledge or consent of their parents.

Example:   [Collected via Twitter, July 2015]

You’ve got to be kidding me! Oregon 15-yr-olds are now allowed to get sex-change operations—w/o parental notification https://t.co/Ldu0p2z3X7 — Franklin Graham (@Franklin_Graham) July 10, 2015

COMING UP: Oregon allowing 15 yr olds to get state-subsidized sex-change operations w/o parental consent-thoughts? @genemarks @DrDanielBober — Gretchen Carlson (@GretchenCarlson) July 10, 2015

Origins:    On 9 July 2015 Fox News published an article titled "Oregon allowing 15-year-olds to get state-subsidized sex-change operations," (accompanied by several broadcast segments) claiming that a recently approved policy in the state enables minors as young as 15 to undergo gender reassignment surgery without the knowledge or consent of their parents.

The article (subsequently aggregated to a number of web sites without additional investigation) stated:

The list of things 15-year-olds are not legally allowed to do in Oregon is long: Drive, smoke, donate blood, get a tattoo — even go to a tanning bed. But, under a first-in-the-nation policy quietly enacted in January that many parents are only now finding out about, 15-year-olds are now allowed to get a sex-change operation. Many residents are stunned to learn they can do it without parental notification — and the state will even pay for it through its Medicaid program, the Oregon Health Plan.

A Portland transgender advocate addressed the claims made in the article, indicating that the assertions were implausible with respect to the mechanics of gender reassignment surgery:

Jenn Burleton, the executive director of TransActive Gender Center in Portland, said the idea a 15-year-old can walk into a doctor’s office, say they want gender affirmation surgery and get it done without a parent’s consent is unrealistic. “It’s irrational,” she said. “It’s laughable.”

The Oregon Health Authority also released a statement about the such claims, explaining that the age of medical consent in Oregon (15) and coverage of gender dysphoria as a medical condition in no way suggested that teens of that age were in actuality undergoing surgery without the knowledge or consent of their parents:

In Oregon, the age of medical consent is 15 or older. Patients should be able to demonstrate the capacity to make a fully informed decision and to give consent to treatment, regardless of age. However, nothing in Oregon law requires a health care provider to provide medical services to a minor or safeguard the confidentiality of a minor. In most cases, providers will encourage (and in some cases require) family engagement and supports unless it would endanger the patient.

The documents to which Fox News referred (which purportedly "quietly" approved gender reassignment for teens) in actuality assessed aligning Oregon's public health coverage (for patients of all ages) with the general standard of treatment for gender dysphoria. Surgery was listed as one of several options available to patients under later revised guidelines and was not specific to minors:

Updating Oregon’s policy and bringing it into line with current major international treatment guidelines, the Health Evidence Review Commission (HERC) has voted to move gender dysphoria into the covered portion of the Prioritized List with the publication of the next biennial review List. Services already approved for this new, covered line include psychotherapy, medical visits, and medications to suppress puberty in gender questioning youth.

The only portion of the documents in question pertaining to minors did not mention parental consent and simply referenced "medications to suppress puberty in gender questioning youth." In terms of utilization estimates in the June 2014 document, Oregon's Health Evidence Review Commission stated that 175 total Oregonians (not specifically or even primarily teens) would likely be covered under the inclusion each year:

HERC staff estimate a utilization rate (of all treatments for gender dysphoria) in OHP of 175 persons in any 12 month period. HERC staff estimates that the total cost of adding all treatments for OHP will be less than $150,000 per year.

The numbers provided are not insignificant with respect to an estimated number of surgeries performed each year. A 2015 Washington Post article quoted two medical experts who estimated that "a woman who chooses the full range of surgical procedures available would spend $75,000 or more to transition to a male," but surgically transitioning "from male to female might cost in the $40,000 to $50,000 range." So even factoring in the lowest cited cost of $40,000 per individual surgery (and the fact that the estimates included all Medicaid patients in Oregon treated for gender dysphoria, not just minors), the "less than $150,000 per year" estimated spending would cover just three patients — with hardly anything left over for non-surgical treatments such as counseling and medication.

The Fox article also cited a 2008 study that stated "most children with gender dysphoria will not remain gender dysphoric after puberty," implicitly suggesting that children in Oregon who might opt for gender reassignment surgery (without any input from their parents regarding the serious health decision) would invariably come to regret their hasty course of action later in life. However, Fox elided the portion of the study that indicated the children presenting as gender dysphoric had an "age range [of] 5-12 years," meaning all study participants were well under the threshold age of medical consent in Oregon. That omission was in contrast to the wording of Fox's headline, which specifically cited minors aged 15 and over (none of which were included in the cited study).

It's true that the age of medical consent in Oregon is 15 (whether or not a minor is transgender), and in early 2015 the state of Oregon's HERC did opt to include gender dysphoria in a list of conditions covered by the state's Medicaid plans. But publicized claims misled readers and viewers into thinking that a new guideline had approved "sex changes" for teenagers by conflating extant Oregon state policies that were largely unrelated.

In fact, the age of medical consent in Oregon has been 15 since 1971, and gender dysphoria Medicaid coverage changes applied to all residents of the state (not teens specifically). The Fox article (and subsequent iterations) failed to consider the lengthy, arduous process gender reassignment entails or the likelihood that any medical provider would agree to begin such a process on a minor who lacked parental consent. Moreover, the policy change was not enacted "quietly" (i.e., without notice or disclosure), as the Associated Press had published an article announcing "Oregon Medicaid to Cover Gender Reassignment" nearly a year earlier.

We've asked out HERC whether additional details are available to determine whether any 15- to 17-year-olds have been affected by the policy update or have undergone gender reassignment in Oregon following the change.

Last updated:    10 July 2015

Originally published:    10 July 2015

By Kim LaCapria

Kim LaCapria is a former writer for Snopes.

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Gender reassignment surgery is now available to oregon minors without parental consent.

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The topic of gender has been much discussed recently, especially with the high-profile case of Bruce Jenner transitioning to Caitlyn Jenner. It’s a very hot-button topic and will probably become even more so once the political debates of 2016 get into full swing.

Gender dysphoria is defined as the condition of feeling one’s emotional and psychological identity as male or female to be opposite to one's biological sex. Though there aren’t any major numbers stating just how many people have gender dysphoria, it is well known that struggling with one’s identity can be a burden not just for the one struggling, but for friends, family, classmates, colleagues, and more.

In Oregon, a controversial new law has been in place since the beginning of 2015 that has left residents of the seemingly forward-thinking state stunned.

Gender reassignment is a procedure that Bruce Jenner underwent to complete his transformation from male to female. While he is a consenting adult, the new law in Oregon allows for minors as young as 15 to get the surgery, even without consent from their parents.

Health Evidence Review Commission (HERC) was petitioned by Jenn Burleton, co-founder of the Portland-based Trans Active Gender Center, to include sex change operations, cross-sex hormone therapy, and puberty-inhibiting medications in the covered procedures for the management of individuals with gender dysphoria. The HERC 12-member panel includes doctors and medical professionals, all of whom are approved by the governor. The change to cover the procedures was settled in January without public debate.

The age of medical consent in Oregon is 15, but how far that consent goes depends on the topic. At 15, teens in Oregon are able to, without their parent’s consent, have sex, receive birth control, take a pregnancy test, and get an abortion. Conversely, according to an article published by IJ Review , 15-year-olds are unable to smoke cigarettes or marijuana, drive alone, send or receive sexts, vote, work more than 18 hours a week, drink, eat unhealthy foods at school, get tattoos, administer aspirin at school or use a tanning bed.

While the new law is very controversial, advocates for it state that it can help reduce suicides in teens with gender dysphoria. When questioned for more information about how many teens have enrolled in the program or how much it would cost the state, HERC distributed a frequently asked questions sheet/fact sheet . It details the background, criteria, medical evidence and what, why and how HERC came about their decision to cover procedures under the new law.

The sheet also states that, although they are certainly able to, at the time of the fact sheet’s publishing, zero teens and 10 adults under the Oregon Health Plan have undergone sex reassignment surgery.

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Oregon Legislature Repeals Surgery Requirement for Gender Change on Birth Certificate

With Gov. Kitzhaber’s approval of HB 2093 yesterday, transgender people in Oregon will no longer have to show proof of surgery in order to change their birth certificates to accurately reflect their gender. Previously, Oregon law required surgery in order to update a birth certificate gender marker, even for those transgender people who did not need or want it, or were unable to access surgery for financial, medical, or other reasons. The ACLU supported the great work of agency and advocate partners to reach this victory. We are glad to see Oregon’s legislature and governor sign off on this important change and advance the rights of transgender Oregonians.

In 2011, the ACLU LGBT Project and the ACLU of Oregon submitted a friend-of-the-court brief on behalf of a transgender woman who was seeking to update her birth certificate but unable to afford surgery. The Linn County Circuit Court later cited our brief in finding the surgery requirement unconstitutional. That case allowed one individual to amend her birth certificate without surgery, but today’s legislation was necessary to fix the problem statewide. The change will take effect January 1, 2014.

Gender identity is a person’s psychological identification as male or female, which for transgender people may differ from that person’s anatomical sex. When an individual transitions his or her gender to better align these two things, that individual’s transition and treatment aim to permit him or her to participate fully and comfortably in society in the gender role with which he or she identifies. While medical treatments, including surgery, are critical to a healthy transition and medically necessary for many transgender people, medical authorities recognize that each transgender person’s specific course of treatment must be determined on an individual basis with the patient’s physician.

Surgery is not a universally required or prescribed aspect of gender transition for every transgender person. Many public and private insurance carriers have historically refused to cover gender-transition-related surgical procedures, leaving them out of reach even for those patients who do need them unless and until those individuals can save or raise tens of thousands of dollars. Whether a transgender person has had surgery is irrelevant to determining his or her gender. And yet, for decades Oregon law has required that transgender individuals seeking to obtain accurate birth certificates undergo costly surgical procedures without regard for whether they wanted or had any medical need for the surgeries.

The ability to obtain correct gender markers on their birth certificates is a right that many Americans take for granted. People often have to show their birth certificates in a variety of situations, from enrolling in school or the military to starting a new job or applying for another form of identification like a driver’s license or passport. Lacking access to accurate birth certificates has stigmatized transgender Oregonians and put them at serious risk of harassment and discrimination.

Long overdue, HB 2093 aligns Oregon law with well-established medical standards. It promotes fairness and equality and makes life easier for transgender people born in Oregon.

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Transgender Health Program

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Transgender Health Program: Insurance Information

OHSU clinics accept many kinds of insurance, including the Oregon Health Plan and many Medicare plans. Some services require prior authorization and referrals.

If you have insurance

Many insurance plans cover some transition-related services. Oregon requires health insurers to cover medically necessary treatments related to gender dysphoria if those treatments are covered for other conditions.

Private insurance

Check your member handbook or call the member services number on your insurance card to find out what may be covered.

Terms to look for: Gender dysphoria, gender identity disorder, sexual/gender reassignment or transgender health.

Oregon Health Plan

The Oregon Health Plan covers hormone therapy and some surgical services for transgender and gender-nonbinary patients. Talk to your health care provider and coordinated care organization to find out what services they may provide.

Learn more:

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If you get health insurance through your job, you should have a summary of benefits. Talk with your company’s benefits specialist or human resources manager about what’s covered.

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Oregon Health Plan: The Oregon Health Plan is the state’s Medicaid program for low-income people. You can apply online if you haven’t already been denied coverage.

Individual marketplace: HealthCare.gov , run by the federal government, helps you shop for and enroll in affordable health insurance. What you pay is based mostly on your income. You can enroll early November through mid-December or after certain life-changing events, such as losing your previous health insurance.

Medicare: This federal program is for people 65 and older and certain younger people with disabilities. Medicare.gov can help you find a plan.

Senior Health Insurance Benefits Assistance Program: This Oregon network of trained volunteers helps Medicare patients of all ages get coverage.

Seniors and People with Physical Disabilities Offices: This Oregon agency , a branch of the Department of Human Services, can help you find services.

Find an agent or application assistant: Visit the Oregon.gov help page to find someone near you to help you find the right coverage.

Help from health insurance agents and Medicare agents is free, but some insurance agents get a commission for recommending an insurer’s plan. For free unbiased help, look for Medicare volunteers and community partners on the Oregon.gov help page.

Recommended community partners: These organizations have expertise in transgender and gender-nonconforming health:

• Cascade AIDS Project offers help to anyone.
• Outside In , which helps homeless and marginalized youths, has a trans services coordinator: 503-535-3828 .
• Project Access Now helps vulnerable communities access health care.

What to ask

These questions can help you decide on an insurance plan, according to the Strong Families Network:

What is covered? When talking to customer service representatives, ask for the “Evidence of Coverage” or “Certificate of Coverage,” a full list of covered benefits for the plan.

What’s not covered? Pay attention to services or treatments specified as exclusions or limitations.

What’s covered for non-trans patients? If hormone therapy, chest surgery and hysterectomies are covered for anyone on the plan, they should be covered for transgender and gender-nonbinary members. In Oregon, it is illegal for insurers to cover services for some people and deny them to others.

Are there hormone therapy co-pays? If so, how much are they? Is there a limit on hormones or hormone injections? If so, what is it?

Is my health care provider covered by the plan ? Check whether your doctor is in the plan’s network.

Is there a network of trans-friendly doctors with training in gender-diverse care? If you want to find a gender-affirming provider,  GLMA: Health Professionals Advancing LGBT Equality  can help. Once you identify someone, ask which plans work with the provider.

Other questions to ask:

• Are there doctors within 30 miles who can serve trans and gender-nonbinary patients?
• Are mental health services available for gender-diverse people and their families, and are visits for gender-related needs covered?
• What kinds of documents are needed to receive services?
• Do I need to change my legal ID to get coverage as a person who is trans-identified?
• Are procedures such as facial gender-confirmation surgery covered?

Dealing with claims

These tips can help you navigate the claims process with your insurer:

• If your insurance is through your employer, contact your company’s benefits specialist or human resources manager.
• Have an advocate nearby or on call, ready to help you handle the stress.
• Be prepared to be misgendered. Many insurance companies don’t train their call-center staff on etiquette for transgender and gender-nonbinary patients.
• Have your group number, plan number and, if you have an online account with your insurer, your username and password.
• Research your plan and be prepared to explain your benefits package. Know what’s included and excluded. Call-center staffers don’t always distinguish well among the insurer’s various plans.
• You may need to ask for a supervisor. Be patient and polite, and remember they’re humans on the other end of the line.
• If you’re told you need a certain form, ask to have a blank copy emailed to you. Use the company’s name for any form, which can help representatives work faster.

These tips can help:

• Don’t despair. You can appeal.
• If you get an operator who can’t help, calmly ask for someone else.
• Don’t accept partial payment. A partial payment can be appealed.
• If you’re insured through work, ask your human resources manager or benefits specialist for help.
• If your employer has a policy on nondiscrimination, inclusion and diversity, you can use it to appeal.
• Find out if your plan has an explicit policy on parity.
• Some claims are denied more than once, even when a procedure is covered.
• If your doctor or benefits specialist finds a successful appeal for the same procedure, remove identifying information and include it with your appeal. This can help you avoid multiple denials.

OHSU resources

Visit our Billing and Insurance page to find:

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The Oregon Department of Consumer and Business Affairs has information about finding insurance, getting help paying for it, and your rights.

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Oregon lawmaker wants to bar transgender teenagers from sex reassignment surgery without parents' permission

• Updated: Sep. 17, 2015, 7:30 p.m. |
• Published: Sep. 17, 2015, 6:30 p.m.
• Casey Parks | The Oregonian/OregonLive

Marijuana committee agrees on early sales

Rep. Carl Wilson, R-Grants Pass, (right) listens at a June 25, 2015, meeting on implementing Measure 91. Wilson wants his fellow lawmakers to ban teenagers from using the Oregon Health Plan to pay for hormones or sex reassignment surgery without their parents' permission. Denis C. Theriault/Staff

(Denis C. Theriault/Staff)

An Oregon legislator wants lawmakers to bar 15-year-olds from using the Oregon Health Plan to pay for sex reassignment surgery.

No minors have yet used the state insurance to pay for such a surgery. But Carl Wilson , R-Grants Pass, said  a 2014 decision to offer Oregon Health Plan coverage for transgender-related medicines and procedures could allow teenagers to make life-altering decisions they will later regret. "We all remember what it's like to be 15," Wilson said. "Some of the decisions we were prepared to make in that time of our life, I'm really not sure we thought about the lasting implications of those things." LGBT advocates say Wilson's push is misguided: The age of consent for all medical and dental procedures in Oregon is 15, and excluding one procedure would be discriminatory. "This is deeply disappointing," said Jeana Frazzini, co-director at the LGBTQ advocacy group Basic Rights Oregon . "We believe that doctors, patients and families should be allowed to decide the best course of treatment on a case-by-case basis. There's no need to carve out an exception when the care is related to gender dysphoria." Oregon's state Medicaid began covering hormones and some surgical procedures this year after the state Health Evidence Review Commission , which examines medical research to determine the coverage priorities for Oregon Health Plan, deemed the treatments "medically necessary" for transgender Oregonians. The 2014 decision didn't specify an age limit, but Oregon's medical age of consent has been 15 since 1971. That means a 15-year-old can go to the doctor or the dentist, seek birth control or a root canal, all without a parent's OK. They can also agree to have surgeries. Wilson, the deputy House Republican leader, said he decided to introduce legislation after hearing from more than 50 "outraged" parents and grandparents. Wilson said his staff rarely hears from that many people. Only Senate Bill 941 , a 2015 legislation requiring background checks for private gun sales, inspired as many calls. His constituents said government officials had "overreached," Wilson said, in allowing teenagers to "go behind their parents' backs" to seek care. The age of consent has come under fire before: In 2012, after the Affordable Care Act guaranteed coverage of sterilization,  conservative activists worried 15-year-olds could be sterilized without their parents' knowledge. Wilson said he has heard advocacy groups such as Basic Rights mention the 2011 survey that showed 40 percent of transgender Oregonians have attempted suicide. The state review board agreed with doctors and activists who testified that coverage of hormones and some surgeries will reduce the rates of suicide, anxiety and depression for transgender patients. "While I do think that is a noble thing to consider," Wilson said, "the greater thing to consider here is if we let 15-, 16- or 17-years-olds do this without the knowledge of their parents, they might wind up waking up one day realizing they have made the mistake of a lifetime." He doesn't know if anyone in his district has used the benefit. He said he hasn't, as far as he knows, ever met a transgender person. So far, 10 adult patients have used Oregon Health Plan benefits to pay for surgeries including the removal of breasts and testicles, according to data kept by the Oregon Health Authority.

No patients younger than 17 have used the benefit to pay for sex reassignment surgery. More than 50 minors have used state coverage to pay for therapy related to gender dysphoria, the medical diagnosis for someone who is transgender. The coding for all 56 of those visits indicated that family members were involved, said Stephanie Tripp, a spokesperson for the Oregon Health Authority. Another 17 minors have used the state insurance to pay for hormone treatments or puberty-suppressing medications. Though Oregon law allows 15-year-olds to pursue sex reassignment surgery, surgeons can decide not to operate. "This isn't surgery on demand," Frazzini said. "It's a significant process with plenty of built-in safeguards." In Oregon, surgeons require several things before performing sex reassignment surgery on a patient. They ask for two letters from a licensed therapist. Some surgeons require patients to have been on hormones for a year. Doctors can also take into account whether a patient has family or friends' support to help during recovery. Wilson said he knows the treatments are not "walk-up service." "But if the government opens up an opportunity for something to happen," he said, "it will ultimately happen." Wilson said his legislation will only focus on taxpayer-funded procedures for teenagers. He won't challenge a teenager's right to use private insurance to pay for gender dysphoria treatment, and he won't immediately try to repeal the state coverage for adults. He hasn't talked with fellow legislators about the proposal, but he "trusts" they will support him. Frazzini said her organization will fight his legislation. "This is life-saving treatment for transgender Oregonians," Frazzini said. "If he does in fact propose legislation, we'll be there every step of the way to defeat it. We're working not only to advance policy but to defend our victories everywhere they're challenged." -- Casey Parks

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Bill expanding abortion, gender-affirming care access moves forward in Oregon

A sweeping bill intended to expand access to abortion and gender-affirming care passed the Oregon House on Monday, despite Republicans' repeated attempts to block the measure.

The bill passed with a 36-23 vote after House members spent nearly 10 hours on the floor. House Speaker Dan Rayfield repeatedly urged Republicans to maintain proper decorum and stick to talking about the bill’s provisions.

The measure, Oregon House Bill 2002, would:

• Allow minors younger than 15 years old to get abortions without parental approval
• Expand state coverage of medical services for transgender individuals. Access to services to help reverse gender transition also would also be covered by the legislation after Republicans voiced concern for those wishing to de-transition after receiving gender-affirming care.
• Require state-regulated and Oregon Health Plan insurance coverage of "all medically necessary gender-related services that are prescribed in alignment with accepted standards of care."
• Repeal a statute that makes concealing the birth of a infant a misdemeanor. Democrats have described the statute as "antiquated," saying it came out of a desire to criminalize having sex out of wedlock.

The measure now heads to the state's Democratic majority Senate before going to Democratic Gov. Tina Kotek for her consideration.

“House Bill 2002 moves Oregon forward in our work to ensure a more just, equitable healthcare system by stopping politicians from interfering in personal medical decisions, closing gaps in insurance coverage, and increasing access to care,” said Rep. Rob Nosse, D-Portland, in his opening statement introducing the measure.

Abortion laws by state: Searchable database of state-by-state abortion limits and protections

How does Oregon House Bill 2002 compare nationally?

The reproductive-health and access-to-care bill has been a legislative priority for Oregon Democrats since the U.S. Supreme Court’s ruling in June left abortion access up to individual states. Republican-led legislatures nationwide have since introduced and, in some cases, passed more than 400 anti-LGBTQ bills limiting or blocking access to reproductive and gender-affirming care.

Oregon's bill also covers parental involvement laws for abortion access. Twenty-six states require parents' involvement in a minor’s decision to have an abortion, Rebecca Wang, legal support counsel at the reproductive justice organization If/When/How, told USA TODAY in February. Some require parental consent. Others only require that parents be notified. And four states — Wyoming, Utah, Virginia and Florida — require both, Wang said.

Many minors may fear parental involvement could have severe consequences, such as being forced to continue a pregnancy, abuse, loss of housing or economic support, and alienation from their families, Wang said. Others may be in the foster care system and may not have access to a parent who can give consent.

"We know that most young people who can involve a parent in their reproductive health decisions, do so," Wang said. "For young people who cannot, it's usually due to some challenging circumstances."

Follow Sydney Wyatt on Twitter @sydney_elise44 .

New rules proposed for licensing electrologists, increasing gender affirming care access

New proposed electrology rules in Oregon seek to reduce barriers to becoming a licensed electrologist, to reduce the wait time of up to two years for hair removal for transgender individuals seeking gender reassignment surgery.

There are about 78 licensed electrologists in Oregon, and there are no electrology schools currently taking new students.

The new rules would allow for a new route to licensure through a 600-hour electrology training program at any licensed body art facility. Trainees would have a temporary license while working directly under an approved supervisor.

The rules also would make it easier for individuals licensed in other states to obtain an Oregon electrology license.

Transgender individuals seeking gender reassignment surgery typically first get hair removal before surgical procedures. But there is a one to two year wait for such electrolysis in Oregon because of the lack of providers, according to the proposal document.

Medicaid began allowing coverage for gender affirming healthcare in 2015, but with the lack of electrology providers in Oregon, finding one who takes Oregon Health Plan can be another barrier for some, said Seth Johnstone, transgender justice program manager at the health care advocacy organization Basic Rights Oregon.

In early 2022, Basic Rights Oregon , as well as electrology professionals and individuals seeking gender reassignment surgery, asked the Health Licensing Office and the Board of Electrologists and Body Art Practitioners to find ways to reduce barriers to accessing electrolysis.

A temporary order was issued in April 2022 allowing electrologists licensed in other states to practice in Oregon if the licensing examination they took was comparable to Oregon’s.

A hearing was held on Wednesday for public comment on the new proposed rules.

Multiple current providers attended, some saying there should be strict guidelines on the qualifications for becoming a supervisor for the proposed training program.

One current electrologist suggested supervisors have a minimum of five years of post-licensure work experience. She worried that rushing into this program would “take away from the integrity of the profession.”

Anyone wishing to provide comment on the new proposed rules can do so through noon Jan. 28 by emailing Samie Patnode at [email protected] or by mail at Attn: Samie Patnode Health Licensing Office, 1430 Tandem Ave. NE, Suite 180, Salem, OR 97301-2192

What is gender-affirming care?

Most broadly stated, gender-affirming care is care that respects and validates a transgender, non-binary, or intersex person’s experience. In terms of accessing transition-related treatment, gender-affirming care refers to interventions that support people in their gender transition. 

Click on a link below to view our gender-affirming care handout:

• Traditional Chinese
• Simplified Chinese

What type of gender-affirming care does CareOregon cover?

CareOregon’s coverage includes medically-necessary transition-related healthcare as established by the Oregon Health Plan and House Bill 2002 . These services include coverage for puberty suppression, primary care and specialist doctor visits, mental health care visits, hormone therapy, electrolysis, top surgery, bottom surgery, body contouring, facial gender confirmation surgery, lab work, and more. 

Click on the arrows below for dropdown lists of covered medical and surgical services. If you have questions or don't see your desired care listed, please call Customer Service at 503-416-4100 , toll-free 800-224-4840 (TTY 711 ) for additional information. Please note: s ome services may require prior approval. 

Medical care

• Hormone therapy
• Puberty blockers
• Hormone blockers
• Mental health therapy, including letters of support
• Electrolysis
• Surgical site hair removal
• Pre-and post-surgical pelvic physical therapy
• Speech therapy
• Medical tattooing

Surgical care

• Mastectomy & chest reconstruction/reduction
• Breast augmentation & mastopexy
• Urethroplasty
• Orchiectomy
• Phalloplasty
• Metoidioplasty
• Scrotoplasty
• Penile & testicular implants
• Scrotectomy
• Nullification surgery
• Clitoroplasty
• Vaginectomy
• Vaginoplasty
• Vulvoplasty
• Hysterectomy
• Salpingo-oophorectomy
• Facial gender confirmation/facial feminization surgery
• Tracheal shave
• Body contouring
• Surgical revisions

Where can I find gender-affirming care?

CareOregon contracts with many licensed behavioral health professionals, primary care doctors, specialists (such as endocrinologists), and surgeons who can provide gender-affirming care.

Gender-affirming care providers, those with experience and training in working with people who are a wide variety of genders, can be found in the lists below.

Please note:

• These lists are updated quarterly and are current as of October 2023.
• For security, some providers go by first name only.
• Many behavioral health providers offer services statewide.

County codes: Clackamas = CL; Multnomah = MU; Washington = WA

Multnomah county

Provider Name

Owl's Nest North Therapy Joint

Credentials

503-281-1166

André Pruitt

503-860-1213

Rustic Sage, LLC

Madeline Harmon

503-444-8214

Madeline Harmon | Sankofa Counseling

LaTrece Gaither

LaTrece Gaither | Sankofa Counseling

Vanessa Washington

Vanessa Washington | Sankofa Counseling

503-662-2808

Nature Abundance

Madilyn Long

971-264-0944

Madilyn Long, MSW, LCSW | Seasons Mental Health and Wellness

Elisia Lopez-Mendiola

971-910-8918

Elisia Lopez-Mendiola | Healing Tides Counseling

Nohemi Robles Hernandez

she/her/ella

Nohemi Robles Hernandez | Healing Tides Counseling

Leah Gregory

Leah Gregory | Healing Tides Counseling

Kian Kolahi

Kian Kolahi | Healing Tides Counseling

Maddison VanderHoff

Maddison VanderHoff | Healing Tides Counseling

Talle Selhorst

Talle Selhorst | Healing Tides Counseling

S. Devoll | Healing Tides Counseling

Matthew Lucas

503-567-9317

Matthew Lucas, MSW, CSWA | Pulse Wellness

Ian Schroeder

LPC, CADC III

503-445-7699

Ian Schroeder | Prism Health

Katya Ludwig

971-319-4827

Katya Ludwig | Sprout Therapy PDX

Noa Grayevsky

503-765-5733

Noa Grayevsky, MA, QMHP | Full Spectrum Therapy

Aleks Taylor

LPC Associate

Aleks Taylor | Full Spectrum Therapy

Quinn Connick

Quinn Connick | Full Spectrum Therapy

Chloe Jacobson

Chloe Jacobson | Full Spectrum Therapy

Julie Cloutier

Julie Cloutier | Full Spectrum Therapy

Dave Eccles

Dave Eccles | Full Spectrum Therapy

Oriol Zemko

FNP-BC, MSN

Oriol Zemko | Full Spectrum Therapy

Gabby Hancher

Counseling Practicum Student

Gabby Hancher | Full Spectrum Therapy

Eli Cuda | Full Spectrum Therapy

Gracen Tichelaar

Gracen Tichelaar | Full Spectrum Therapy

Del Likins | Full Spectrum Therapy

Jenny Lee | Full Spectrum Therapy

Kayla Daniels

LCSW, CADC I

Kayla Daniels | Prism Health

Mattie Boucher

Mattie Boucher | Prism Health

Andrew Decker

Andrew Decker | Prism Health

Chance Hessel

Chance Hessel | Prism Health

Rain Estrada

503-476-1068

Deirdre Rundle

503-300-1941

Lodestar Mental Health Services, LLC

Vivi Nguyen

503-486-8936

Vivi Nguyen | Brave Space

LCSW, CADC II

Tara Rose Therapy

Quinn Rivenburgh

MAAT, ATR-BC, LAT, LPC

Quinn Rivenburgh | Portland Therapy Center

Elise Himes

971-270-0167

Elise Himes | Health Allies Counseling

Alyssa Nagel

Alyssa Nagel | Health Allies Counseling

Jack Marvin

503-974-6885

Jack Marvin | Portland Therapy Center

Sasha Strong

MA, PhD, LPC

971-279-7261

Sasha Strong, MA, PhD, LPC | Portland Therapy Center

Sid Napier, MS | Full Spectrum Therapy

ATR, LAT, LPC

Sam Skye | Portland Therapy Center

Kaspar Woods

Kaspar Woods | Brave Space

Anna Cullop

503-568-1499

Anna Cullop, LPC | Cocoon Counseling Services

Colette Gordon

503-780-4169

Colette Gordon | Do It Together Counseling

971-200-5254

Kat Canada, LCSW | Portland Therapy Center

River Fagan

503-917-4768

Dragonwise Counseling and Consulting

Casey Granbois

503-622-8964

Casey Granbois, MSN, PMHNP | Portland Mental Health and Wellness

Jake Balinky

Jake Balinky | Portland Mental Health and Wellness

Trevor Rachko

503-460-0405

Trevor Rachko | Bridge City Family Medical Clinic

Eva Cicilian

Eva Cicilian | Bridge City Family Medical Clinic

Kyle Anderson

Kyle Anderson, PMHNP | Bridge City Family Medical Clinic

Nate Bagley

503-954-2188

Nate Bagley, MA, LPC | Bridge City Family Medical Clinic

971-301-4229

Chris Doud, CSWA | Spectrum Counseling

Rebekah Lubeck

503-260-8612

Rebekah Lubeck, MSW, LCSW | Pulse Wellness Cooperative

Rosanne Marmor

503-936-1924

Rosanne Marmor, MSW, LCSW | Pulse Wellness Cooperative

971-266-4291

Lola Ryan, MSW, LCSW | Pulse Wellness Cooperative

Online contact form

David | Sakura Counseling

Katie | Sakura Counseling

Taryn | Sakura Counseling

Summer | Sakura Counseling

Nancy | Sakura Counseling

Grace | Sakura Counseling

Kelsey | Sakura Counseling

Myra | Sakura Counseling

Clark Hazel

Clark Hazel, LCSW

Jennie FreimoEller

971-361-8303

Stephanie Tolentino

LMFT Associate

Riley Kastenhuber

LMFT Intern

Paris Courtney

Maia Bellavia

Jamie Brkowitz

Elizabeth Knutsen

Melisa De Seguirant

Danielle Walker

Keely Helmick

Cal Reynolds

503-545-6798

Link Therapy

Lacy Cooper

Myra Bazell

503-281-0308

Hands On Medicine

Diana Frates

Claire Tam | Full Spectrum Therapy

Caitlin O'Dell

503-954-2188x19

Caitlin O'Dell M.ED., LMFT | Bridge City Counseling

April Nunez

April Nunez, LMFT | Health Allies Counseling

Brilliancy Counseling

Kaylynne Gray

Kaylynne Gray | Full Spectrum Therapy

Kristen Cole

Kristen Cole | Full Spectrum Therapy

Full Spectrum Therapy

Cole Prophet

Cole Prophet | Full Spectrum Therapy

Vivi Langdon

Vivi Langdon | Full Spectrum Therapy

Sam C. Skye | Full Spectrum Therapy

Sarah Abramovitz

ATR-BC, LCAT, LPC

Sarah Abramovitz | Full Spectrum Therapy

Kaspar Woods | Full Spectrum Therapy

RYT, QMHP-R

Katie Wood | Full Spectrum Therapy

Bridge City Counseling

Monica Melgar-Sharman

Washington county

503-444-8230

Amy Beene, LPC | NW Counseling Associates, LLC

Clackamas and Washington counties

Regina Vander

503-303-0304

Regina Vander, LCSW | A Healing Intention

Jenna Urban

Jenna Urban | A Healing Intention

Sara Amundson

Sara Amundson | A Healing Intention

Destiny Bankhead

Destiny Bankhead | A Healing Intention

Elizabeth La Torella

Elizabeth La Torella | A Healing Intention

Jessica Farrell

Jessica Farrell | A Healing Intention

Jean Phare | A Healing Intention

Cherity Whiteaker

Cherity Whiteaker | A Healing Intention

Andy Vogler

Andy Vogler | A Healing Intention

Clackamas, Multnomah and Washington counties

Dmitri Dosamantes

503-545-2572

Dmitri Dosamantes | Portland Therapy Center

Megan Lester

503-517-8663

Catholic Community Services

Davonna Wilson

ARNP, PMHNP

971-352-6971

Davonna Wilson, PMHNP | Mindful Therapy Group

Clackamas county

LPC, CADC II

503-722-6588

Behavioral Health Division | Clackamas County

Nadine Luensman

360-980-8562

Portland Therapy Center

Arielle Ross

[email protected]

Wandering & Belonging Therapy

Margot Presley

971-361-7700

Pat Buckley

503-228-4533

Richard Bruno

MD, MPH, FAAFP, FACPM, AAHIVS

Wendy Vannoy

971-380-0121

Dr. Wendy Vannoy

Sean Peter Horan

503-236-4580

A Balanced Life Health Care

Suzanne Scopes

503-230-0812

Dr. Scopes Natural Healthcare

Angela Carter

503-459-2584

Dr. Angela Carter, ND

Connie Silverman

Connie Silverman, DNP, FNP-C | Prism Health

Ben Sokoloff

Ben Sokoloff, DO, AAHIVS | Prism Health

Rian Johnson

Rian Johnson, MN, FNP-C | Prism Health

Amy Wiser, MD, FAAFP | Prism Health

Maeve McGarry

Maeve McGarry, DNP, FNP | Prism Health

Elizabeth Yiu

Elizabeth Yiu, MSN, FNP-C | Prism Health

Rachel Jackson

503-535-3800

Rachel Jackson, MD | Outside In

PNP, MSN, MS, RN

Diana Hall, PNP, MSN, MS, RN | Outside In

Emmy Wohlgemuth

Emmy Wohlgemuth, FNP-C, CNM | Outside In

Isabelle Trepiccione

Isabelle Trepiccione, MD | Outside In

Karletia Lewis

503-287-4932

Karletia Lewis, FNP | North by Northeast

Karlyn Nieland

Karlyn Nieland, ANP | Outside In

Mandi Ruscher

MSN, FNP-C, CPEN

Mandi Ruscher, MSN, FNP-C, CPEN | Outside In

Meghan Brinson

Meghan Brinson, ND | Outside In

Miguel Mitchell

Miguel Mitchell, ND | Outside In

Shelda R. Holmes

Shelda R. Holmes, FNP | Hands On Medicine

Kim Kelsey, FNP | Hands On Medicine

Melanie Anthony

Melanie Anthony, FNP | Hands On Medicine

Teri Bunker

Teri Bunker | Bridge City Family Medical Clinic

Gwyneth Jones

Gwyneth Jones | Bridge City Family Medical Clinic

Brittany Kolluru

Brittany Kolluru | Bridge City Family Medical Clinic

Amber Oyama

Amber Oyama | Bridge City Family Medical Clinic

Healthy Living Community

971-438-6112

Ruth Christiansen

503-494-9992

Ruth Christiansen PA-C | OHSU

Dr. Jackson

ND, LMT, CPT

503-882-0752

Dr. Jackson | Sirona Integrated Health

Michelle Williams

Michelle Williams | Sirona Integrated Health

Emily Rose Jacobson

503-418-3900

Emily Rose Jacobsen PA-C | OHSU

Megan Brusca

503-249-1900

Megan Brusca, MD | Broadway Medical Clinic

Darcie Clark

Hands on Medicine

Zannah Martell

Stephen Levy

ND, LAC, LMT

503-831-8116

Soaring Health & Wellness

Planned Parenthood NE Portland Health Center

888-875-7820

Planned Parenthood

Planned Parenthood Hillman East Portland Center

Tove Silver

503-848-5861

Tove Silver | Neighborhood Health Center

Megan Manley

503-352-6000

Virginia Garcia Beaverton Wellness Center

Lisa Kipersztok

Ericka Horner

503-359-4773

Mountain View Medical Center

Planned Parenthood Beaverton Health Center

Telehealth only

Oshin Worthington

503-610-3828

Oshin Medicine

PPSO Telehealth Services

541-344-9411

Planned Parenthood Milwaukie-Oak Grove Health Center

Multnomah and Clark counties

Dr. V Madrigal

MU & Clark (Washington)

503-850-8216

Dr. Venessa Madrigal | Teyolia Natural Medicine

Kaiser Permanente Gender Pathways Clinic

503-249-6748

Northwest Gender Pathways Clinic

503-400-6622

Dr. Tina Jenq, MD | Oregon Cosmetic and Reconstructive Clinic

Tuan A. Nguyen

MD, FACS, DDS

503-635-1955

Lake Oswego Plastic Surgery

503-239-6800

Oscar Polo, MD, FACOG | The Oregon Clinic

503-494-6687

Jens U. Berli, MD | OHSU

Daniel Dugi

503-346-1500

Daniel D. Dugi, III, MD, FACS | OHSU

503-612-5260

Megan Bird, MD | Legacy

Hema Thakar

503-413-4992

Hema Thakar, MD, FACS | Legacy

Jyoti Chouhan

Jyoti Chouhan, DO, PharmD, FACS | OHSU

Toby Meltzer

480-657-7006

Toby Meltzer, MD | Legacy

Richard McNally

503-488-2345

Richard S. McNally, MD | Providence

Juliana E. Hansen

Juliana E. Hansen, MD, FACS | OHSU

Nick Esmonde

Nick Esmonde MD | The Meltzer Clinic

Geolani W. Dy, M.D., F.A.C.S. | OHSU

Jennifer Franz

Jennifer Franz, MD, FACOG | The Oregon Clinic

Lishiana Shaffer

503-418-4500

Lishiana Shaffer MD | OHSU

Krista Jensen

503-413-7353

Krista Jensen, DO

Scott Hoffman

Scott Hoffmann, MD

Sean McNally

Sean McNally, MD, PhD | The Oregon Clinic

Michael Schmitt

Michael Schmitt, MD | The Oregon Clinic

Hetal Fichadia

503-488-2344

Hetal Fichadia, MD, FACS

Please note: These surgeons are only available to Health Share/Kaiser members.

Rahul Kasukurthi

503-652-2880

Rahul Kasukurthi, MD | Kaiser Permanente

Alexander J. Gougoutas

Alexander Gougoutas, MD | Kaiser Permanente

Hao-Jun J. Chong

Hao-Jun Chong, MD | Kaiser Permanente

Patricia H. Sandholm

Patricia Sandholm, MD | Kaiser Permanente

Jennifer A. Murphy

Jennifer Murphy, MD | Kaiser Permanente

Sara Spettel

503-297-1078

Sara Spettel, MD | Northwest Urology

Christopher Razavi

Christopher R. Razavi, MD | OHSU

Sasha Druskin

503-223-6223

Sasha Druskin, MD | Northwest Urology

Marcie Drury Brown

Type of care

Pediatric Endocrinologist

503-216-6050

Marcie Drury Brown, MD | Providence

Karmen Steffan

Voice therapy

971-346-0355

Breatheworks

Hair removal

619-922-9933

Auntie Claire's Permanent Hair Removal

Michelle Cappadona

Michelle Cappadona | OHSU

Jaimee T Bloom

503-224-3300

Portland Electrolysis & Skin Care

Kathryn Trosen

503-410-1751

Heather Onoday

Dermatology

RN, FNP, MN

503-418-3376

Heather Onoday, RN, MN, FNP | OHSU

Radhika Purushothaman

503-413-1600

Radhika Purushothaman, MD | Legacy Health

David Snyder

David Snyder, MD | Legacy Health

Sevket Yigit

Sevket Yigit, MD | Legacy Health

Kara Connelly

503-346-0640

Kara J. Connelly, MD | OHSU

Hayley Baines

Hayley Baines, MD | OHSU

Stephanie Tarlow

P.A.-C, C.D.C.E.S.

Stephanie Tarlow, P.A.-C, C.D.C.E.S. | OHSU

Rowan Everard

Acupuncture

630-297-3705

Inner Sanctuary Wellness

Gender Communication Lab

503-725-3070

Joshua Shindler

503-494-5947

Joshua S. Schindler MD | OHSU

The Wellness Group - Voice, Speech and Swallowing LLC

503-946-6907

The Wellness Group

Jackie Cano

Jackie E Cano MA | OHSU

Alice Berry

503-701-4900

Transformations Electrolysis LLC

Maya Hunter

Maya Hunter, MD | Legacy Health

Karin Selva

Karin Selva, MD | Legacy Health

Monte Nido - West Linn

Eating disorder residential treatment

888-228-1253

The Living Room 

Community center & peer support

503-825-2535

The Living Room

Prism Health

primary care, hormone therapy and mental health care clinic

Transgender Health Program - OHSU

Education, case management, community support

503-494-7970

The Equi Institute (previously Sacred Vessel)

Case management, community support, and peer support

The Equi Institute

Northwest Gender Pathways Clinic - Kaiser

Advocacy, community supprt

Contact form

Portland Two Spirit Society

Community support

Facebook page

Portland Two Spirit Society - Facebook page

TransActive Gender Center

503-768-6024

Lewis & Clark Graduate School TransActive Gender Project

Sexual & Gender Minority Youth Resource Center (SMYRC) - New Avenues for Youth

503-872-9664

The Q Center

503-234-7837

Me Cuido, Te Cuido Trainings - Familias en Accion

503-201-9865

Black and Beyond the Binary Collective

Education, community support, mutual aid

971-258-1713

The Queer Resource Center - Portland State University

Community center

503-725-3000

primary care and hormone therapy clinic

503-535-3860

Quest Center for Integrative Health

503-238-5203

gender-affirming voice and communication techniques

Website Intake form

True Colors Recovery

Community center & peer support, substance use recovery

online contact form

Mental Health & Addiction Association of Oregon

Peer support

503-922-2377

PDX Trans Housing Coalition

PDX Trans Housing Coalition - Facebook page

STRIDE (LifeWorks NW)

Peer support & case management

503-619-9007

LifeWorks NW Prevention Services

Doernbecher Gender Clinic (Pediatric) - OHSU

primary care, hormone therapy and mental health for gender diverse youth and families

Doernbecher Gender Services

Legacy's T-Clinic (Pediatric)

Randall Children's Gender Care Center

Rahab's Sisters

community gatherings, mental health support, street outreach

971-208-3176

Clackamas, Multnomah, Washington and Clark counties

Northwest Gender Alliance

CL, MU, WA, Clark Co

Community support & peer support

AFFIRM Groups

mental health support for youth

AFFIRM - Options Counseling and Family Services

Planned Parenthood Southwestern Oregon

Basic Rights Oregon

Advocacy organization

503-222-6151

Out Dance Project - Boom and Bust

Statewide and Clark county

Planned Parenthood Columbia Willamette

Statewide & Clark Co

888-576-7526

Beyond These Walls

Project HEAL

Eating disorder support

FEDUP Collective

The FEDUP Collective

Dem Bois Inc.

financial assistance to person(s) of color for gender affirming surgeries

Website intake form

Dem Bois website

What are the steps to accessing services?

1. start with your primary care and mental health providers.

They can help you with most everything from your initial gender dysphoria diagnosis to accessing hormone treatment and/or surgeries. In some cases, it is necessary to have a referral from a primary care provider and a mental health provider in order to schedule a consult for surgery. You can search for providers from the lists above or by calling Customer Service.

2. Familiarize yourself with medical interventions and what feels best for you

There are a variety of options available when it comes to hormonal and surgical interventions. Some surgeons in our network perform different surgeries and have different techniques they use for each. We recommend contacting a surgeon’s office to review surgery types, recovery timelines, considerations and risks, along with any other questions you may have. Please note that hormonal and surgical intervention for people under 18 is limited and additional screening may be required.

3. Determine if getting a diagnosis of what has come to be called gender dysphoria is appropriate or needed to access the care you want and if so, get it in writing

Be sure your gender dysphoria evaluation is from a mental health provider qualified to diagnose gender dysphoria. Clinicians with a minimum of a Master’s degree are eligible to write letters diagnosing patients with gender dysphoria for the Oregon Health Plan. These letters must be completed by a licensed clinician or an unlicensed clinician with a licensed clinical supervisor’s signature. These letters may be referred to as “assessment letters” or “letters of support” and are necessary for accessing surgery and, in some cases, changing your gender marker on identity documentation (e.g., birth certificate, state ID, etc.). Bottom surgeries require two assessment letters.

If you need help with accessing services, or if you want to talk to someone about the services CareOregon provides, call Customer Service at 503-416-4100 , toll-free 800-224-4840 or TTY 711 .

Additional CareOregon resources

CareOregon supports transition needs outside of medical interventions. Members and their care providers can request health-related services funds (HRSF)  for items or services that aren’t covered under standard Oregon Health Plan services, but will improve a person’s health. HRS must be consistent with a member’s treatment plan, as developed by their primary care team or other treatment providers.

Some examples of items that can fall under HRSF are:

• gender affirming clothing
• prosthetics
• costs related to name changes
• gender marker changes
• identity documentation

For more information, please visit our health-related services webpage .

Outside resources

Oregon Health & Science University (OHSU) Transgender Health Program

State and nationwide resources  

Oregon Health Authority GUIDELINE NOTE 127, GENDER AFFIRMING TREATMENT

OHSU Transgender Health Program's Resources for Youth, Adults, Families, and Allies

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• News and stories

Reproductive health care bill passes Oregon House, despite Republican delay tactics

Oregon legislators spent hours Monday debating House Bill 2002, a polarizing package involving abortion and gender-affirming health care, before ultimately voting it through to the state Senate.

Republicans fought, stalled and objected. But majority Democrats in the Oregon House waited them out, and late Monday ended up passing, by a vote of 36-23, a broad reproductive health care bill.

House Bill 2002 would require Medicaid and private insurers to cover more procedures under the umbrella of gender-affirming care, and would allow minors of any age to get an abortion without needing to notify a parent, among other policies.

It now goes to the Oregon Senate, where Democrats also have a large majority over Republicans.

HB 2002 aims to protect abortion providers, expand gender-affirming services covered by Medicaid

HB 2002 was crafted by Democrats following the Supreme Court decision last summer overturning Roe vs. Wade and in response to a push by Republican legislators in other states to pass limits on gender-affirming care for youth.

Oregon already has among the most liberal laws in the country with regards to abortion and some of the nation’s strongest legal protections for LGBTQ+ civil liberties.

State law allows for abortions with no restrictions. It also requires state Medicaid and most private medical insurers to cover abortions and some gender-affirming care, including hormone therapy and some surgeries.

Democrats framed the bill as an effort to protect patients’ privacy rights, close gaps in insurance coverage, and increase access to abortion and gender-affirming care in rural parts of the state.

The bill would expand the scope of care Medicaid and private insurance is required to cover in Oregon to include laser hair removal and facial feminization surgery.

Related: From cosmetic to critical: Oregon, other states work to boost trans health coverage

It would also protect health care providers who perform abortions or gender-affirming care from legal repercussions.

“We need to make sure here in Oregon that our law is absolutely clear, so that our providers can provide care in every unique scenario,” said Rep. Rob Nosse, D-Portland, who carried the bill.

Republicans said the omnibus bill does too much, hasn’t received proper scrutiny and would undermine parents’ rights in sensitive medical decisions.

“This is a parental rights issue and a process issue,” said House Minority Leader Vikki Breese-Iverson, R-Prineville. “This is Oregon effectively telling you the government understands the needs of your child better than you do.”

FILE: House Minority Leader Vikki Breese-Iverson, R-Prineville, left, and Rep. Bobby Levy, R-Echo, while in session at the Oregon State Capitol in Salem, March 20, 2023.

Kristyna Wentz-Graff / OPB

Republicans also argued that there hasn’t been a transparent accounting of the full cost of the bill. In a fiscal impact statement prepared in March, the Oregon Health Authority could not come up with an estimate of how much HB 2002 would cost the state’s Medicaid program, but said it could increase the number of procedures that are covered rather than denied on the basis that they are cosmetic.

Republicans attempted multiple procedural moves to delay the vote, challenging whether the summary of the bill met legal standards for clarity and attempting to refer HB 2002 to other committees for debate. Those moves ultimately failed, with the bill finally going to a vote late Monday night. The bill also addresses the limited number of abortion and gender care providers outside the Willamette Valley, an issue that intensified after Idaho’s abortion bans took effect , closing clinics in Boise that were the closest option for some patients in Eastern Oregon.

HB 2002 would create a pilot project to deploy two mobile health clinics to provide abortion, gender-affirming care, and other reproductive health services in rural areas. And it requires student health centers to provide enrolled students with access to emergency contraception and medication abortion.

Republicans, many of whom represent rural districts, oppose the pilot project. They called it another example of Portlanders trying to dictate policy to rural communities without listening to them.

“These Oregonians do not want more of their taxpayer dollars going to something they fundamentally disagree with,” said Rep. Christine Goodwin, R-Canyonville. “Ask them how they feel about a mobile abortion truck parked in their neighborhoods.”

The bill also targets abortion clinic protesters by making it a crime to block people who are trying to enter a health care facility or by making noise or phone calls that interfere with facility operations.

House floor debate demonstrates partisan divide over abortion

Some of the most heated and emotional objections from Republicans came over the bill’s language that would give minors under 15 the right to access reproductive health care information and services, including abortion, without needing parental consent.

HB 2002 would also limit the situations in which a medical provider can disclose to a parent that their child has had an abortion or sought other reproductive health care, if the child objects to that disclosure.

In Oregon, state law already allows minors 15 years and up to consent to their own medical care. The state does not have any statutes currently on the books regarding parental notification or consent specifically for abortions.

Republicans have used the hypothetical case of a 10-year-old girl getting an abortion without notifying her parents, which would be legal under HB 2002.

They argued that the bill would undermine parents’ rights in sensitive medical decisions, and could keep parents in the dark in a situation in which their child had been the victim of rape and abuse.

Rep. Lily Morgan, R-Grants Pass, disclosed her history as a survivor of child abuse while urging her colleagues to oppose the bill and indefinitely postpone voting on it.

Morgan said that while she was never personally pressured to get an abortion, she was intimidated by her abuser to remain silent about her experience. She fears the bill will make it easier for a pregnancy of a child under 15 to be hidden from their parents, allowing abuse to continue.

“I was not empowered or equipped to handle the situation on my own,” Morgan said.

Rep. Lisa Reynolds, D-Beaverton, invoked her experience as a pediatrician in defending the limits to parental notification in the bill and in current state law.

Reynolds said the standard of care pediatricians follow is to involve parents in child’s care, except in exceptional circumstances.

“This is only in the infrequent and heartbreaking circumstances when the parents are not the safe adults in that young person’s life,” Reynolds said.

Reynolds also noted that health care providers are mandatory reporters of child abuse.

“If a 10-year-old is pregnant, a horrific act and crime has taken place,” she said. “I would tend to that child and then I would call law enforcement and child welfare.”

FILE: Rep. Lisa Reynolds, D-Beaverton, speaks on the floor of the House at the Oregon State Capitol in Salem, March 20, 2023.

While no lawmakers cited it, research suggests that a majority of minors involve their parents in the decision to seek an abortion, whether or not they are legally required to.

Lauren Ralph is an epidemiologist with the University of California, San Francisco, whose research focuses on young people’s access to abortion.

Ralph said a handful of studies, including her own research in Illinois, have looked at the issue of parental notification and found relatively consistent results.

Ralph said in states with no parental notification requirement, about two-thirds of minors seeking abortions voluntarily involve their parents in the decision, most often their moms. Between 80% and 90% involve some adult — a parent, relative, teacher, counselor or member of their religious community, according to Ralph.

In her research, younger minors were much more likely to involve their parents, with over 90% of 14- and 15-year-olds involving a parent in their decision voluntarily, and the percentage falling among 16- and 17-year-olds.

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This State Just Outlawed Gender Reassignment Surgery on Children

Republican Gov. Mark Gordon (R-WYo.) signed a series of bills banning gender reassignment surgery on minors. However, he rejected a bill that would have elevated significant barriers to abortion,

On Friday, Gordon signed the “Children gender change prohibition," legislation into law, which bans physicians from performing gender-reassignment procedures on children and administering such medications that would alter their body chemistry.

"I signed SF99 because I support the protections this bill includes for children, however, it is my belief that the government is straying into the personal affairs of families," Gordon said in a statement. "Our legislature needs to sort out its intentions with regard to parental rights. While it inserts governmental prerogative in some places, it affirms parental rights in others."

The law will prohibit any “surgery that sterilizes the child, including castration, vasectomy, hysterectomy, oophorectomy, metoidioplasty, orchiectomy, penectomy, phalloplasty and vaginoplasty." 

It will also ban related prescription drugs “that induce transient or permanent infertility," or are considered a “puberty suppression or blocking prescription drugs to stop or delay normal puberty."

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However, Gordon vetoed the “Regulation of abortions” bill, which would have placed further restrictions on abortions in the state.  

The legislation would have "properly regulated surgical abortion clinics in Wyoming," however, the governor noted that the "amendments to the bill complicated its purpose, making it vulnerable to legal challenges."

“It is my opinion that HB148, as amended, had the potential to further delay the resolution of this critical issue for the unborn," Gordon said in the statement. "The potential of starting over on a new course of legal arguments would in my mind be derelict, and would have only sacrificed additional unborn lives in Wyoming."

The bill would have classified abortion clinics as a “ambulatory surgical center.”

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Wyoming governor signs bill outlawing gender-reassignment procedures on children, vetoes abortion restrictions

Wyoming's Republican Governor Mark Gordon signed into legislation Friday a bill outlawing gender-reassignment procedures on children and vetoed a bill that would have imposed further restrictions on abortion clinics, including required licensure. 

SF0099, also titled "Children gender change prohibition," prohibits physicians from performing gender-reassignment procedures on children and administering related medications. The legislation specifically banned "a surgery that sterilizes the child, including castration, vasectomy, hysterectomy, oophorectomy, metoidioplasty, orchiectomy, penectomy, phalloplasty and vaginoplasty." 

The legislation continued on to specify that outlawed medications under the legislation included "any of the following prescription drugs that induce transient or permanent infertility," proceeded by a list of medications , including "puberty suppression or blocking prescription drugs to stop or delay normal puberty."

WYOMING JUDGE TO RULE ON ABORTION LAWS, INCLUDING THE FIRST-IN-THE-NATION BAN ON ABORTION PILLS

The bill also outlined various procedures that were exempt from the legislation, such as procedures or treatments performed on a child as a result of "a medically verifiable genetic disorder of sex development." The legislation specified that parental/guardian consent was required. 

"I signed SF99 because I support the protections this bill includes for children, however, it is my belief that the government is straying into the personal affairs of families" Gordon said in a statement released. "Our legislature needs to sort out its intentions with regard to parental rights. While it inserts governmental prerogative in some places, it affirms parental rights in others."

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Gordon also vetoed HB0148, known as "Regulation of abortions," that would have placed additional restrictions on abortion clinics in the state. The press release noted that the bill would have "properly regulated surgical abortion clinics in Wyoming," but "amendments to the bill complicated its purpose, making it vulnerable to legal challenges."

The legislation would have required a surgical abortion facility in the state to be licensed as "an ambulatory surgical center," and a facility conducting the procedures would need a separate license as well. 

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"It is my opinion that HB148, as amended, had the potential to further delay the resolution of this critical issue for the unborn," Gordon said in the statement. "The potential of starting over on a new course of legal arguments would in my mind be derelict, and would have only sacrificed additional unborn lives in Wyoming."

Abortion is currently legal in Wyoming, pending a court decision challenging the state's abortion laws.

On the national scale, the U.S. Supreme Court is set to hear oral arguments Tuesday about the federal government's approval process of the drug mifepristone, a medication used to terminate pregnancies. A ruling is expected about three months later.

The Supreme Court is currently allowing the FDA to continue regulating the drug while the appeals process plays out. Such regulation includes continued telemedicine prescriptions and retail pharmacy dispensing.

Fox News' Shannon Bream, Bill Mears and The Associated Press contributed to this report. 

Original article source: Wyoming governor signs bill outlawing gender-reassignment procedures on children, vetoes abortion restrictions

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Using public funds or facilities for gender-affirming care banned by GOP-led Idaho Legislature

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BOISE, Idaho (AP) — The GOP-led Idaho Legislature has passed a bill that would ban the use of any public funds for gender-affirming care, including for state employees using work health insurance and for adults covered by Medicaid.

The Senate overwhelmingly approved the measure Friday after it previously passed through the House. It will be sent to Republican Gov. Brad Little’s desk, where he is expected to sign it into law. The governor has said repeatedly he does not believe public funds should be used for gender-affirming care.

If the legislation is enacted, Idaho would become at least the 10th state to ban Medicaid funding for gender-affirming care for people of all ages, according to the advocacy and information organization Movement Advancement Project. The laws are part of an ongoing national battle over the rights of LGBTQ+ Americans .

The American Civil Liberties Union of Idaho in a statement Friday condemned the Senate’s decision.

“Idaho’s state senators have once again decided to cave in to the hateful demands of far-right extremists at the expense of the safety, security, and health of Idaho’s transgender community,” the statement said, adding that lawmakers could simply choose to allow transgender people in Idaho to make their own medical decisions in peace.

The ACLU and other opponents of the Idaho bill say it almost certainly will lead to a lawsuit in federal court. The state is already embroiled in lawsuits over attempts to deny gender-affirming care to transgender residents and so far has not had much success defending them.

In one case, the state was ordered to provide a transgender inmate with gender-transition surgery, and the inmate was later awarded roughly $2.5 million in legal fees.

A federal judge barred Idaho last year from enforcing its newly enacted ban on gender-affirming medical care for minors until a lawsuit brought by transgender youth and their families is resolved. A different federal judge denied the state’s motion to dismiss a separate lawsuit filed by adults in 2022 who said Medicaid officials wrongly denied coverage for their medically necessary gender-affirming treatment.

“This bill violates the 14th Amendment equal protections clause” and the federal Medicaid Act, Boise attorney Howard Belodoff told lawmakers last week during a hearing.

One of the bill’s sponsors, Republican Rep. Bruce Skaug, described it as a taxpayer protection bill, suggesting that without it the state could end up paying millions for gender-affirming care. About 70% of Idaho’s Medicaid program is federally funded.

Some who testified against the bill suggested it could have a far larger reach than intended by eliminating gender-affirming care for even privately insured residents living in rural areas with only state-funded medical centers.

The punishment for violating the law would include fines ranging from $300 to $10,000 and imprisonment between one and 14 years.

At least 23 states including Idaho have passed laws banning gender-affirming care for minors . Some states also have considered policies that experts say make it more difficult for transgender adults to receive care, such as eliminating telehealth options or requiring repeated psychological examinations for continued gender-affirming treatment.

Major medical groups, including the American Medical Association and the American Academy of Pediatrics , oppose gender-affirming care bans and have endorsed such care, saying it is safe when administered properly.

While courts have blocked the enforcement of gender-affirming care bans for minors in Idaho, Montana and Arkansas , they have allowed enforcement in Alabama and Georgia .

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Wyoming Bans 'Gender-Reassignment,' Puberty Blocking Procedures for Children

The state of Wyoming has outlawed “gender-reassignment” procedures for children in an effort to ban the permanent sterilization, castration, and mutilation of minors. Gov. Mark Gordon (R) signed SF0099, also known as the “Children gender change prohibition,” into law on Friday. The law allows exceptions for “procedures or treatments that are performed with the consent of the child’s parent or guardian and are for a child who is born with a medically verifiable genetic disorder of sex development.” “I signed SF99 because I support the protections this bill includes for...

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