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World Progress · United States

Federal record and the states

Many states have banned or limited sex-rejecting procedures — puberty blockers, hormones of the opposite sex, and surgeries meant to make a child look like the opposite sex. In June 2025 United States v. Skrmetti said those state bans may stand. A federal Medicaid and children’s-insurance (CHIP) rule (CMS-2451-F) stops taxpayer funding for those procedures on minors.
Mixed

2025–2026

Many states banned or limited sex-rejecting procedures for minors, the Supreme Court said those state bans may stand, and a federal Medicaid rule cuts funding for those procedures on minors.

Official sources

Federal actions

United States v. Skrmetti (18 June 2025)

The Supreme Court upheld Tennessee’s SB 1 against an Equal Protection challenge. State bans may stand.

Supreme Court opinion (PDF) →

HHS evidence review (November 2025)

HHS published a peer-reviewed evidence review on treatment for pediatric gender dysphoria. It is an evidence document, not a procedure ban.

HHS Office of Population Affairs →

CMS Medicaid / CHIP funding rule — FINAL

CMS-2451-F ends federal Medicaid funding under 18 and CHIP (Children’s Health Insurance Program) funding under 19 for sex-rejecting procedures, effective 13 October 2026. A 22-state and D.C. suit is pending; the rule has not been blocked. This is a Medicaid and CHIP funding rule.

Federal Register — final rule →

Official complaint →

States and D.C. — 50 states plus D.C.

  • Medical · Ban · 22
  • Medical · Restriction · 3
  • Medical · Litigation-setback · 2
  • Medical · Proposed bill · 3
  • Medical · No ban · 21
  • Schools · Schools ban · 2
  • Schools · Schools restriction · 6
  • Schools · Schools mixed · 1
Medical status map

click a state for more details.

  • BanStatute in force.
  • RestrictionNarrower than a total ban.
  • Litigation-setbackBan or limit was enacted, then a court blocked it. The statute is on the books; it is not enforced.
  • Proposed billA bill has been introduced. It is not law yet.
  • No banNo statewide medical ban. Shield laws, if any, are in the state summary.
United States map colored by pediatric medical-transition statusEach state uses the same Ban, Restriction, Litigation-setback, Proposed bill, and No ban colors as the alphabetical cards. No ban is solid light gray. Proposed bill is that gray with white stripes. Some No ban states also have a shield law — that detail is on the state card, not a second map color. Litigation-setback states are paper with blue diagonal stripes: a ban or limit was enacted, then a court blocked it. District of Columbia is labeled in an inset. Click a state to jump to its note.Alabama — BanAlaska — No banArizona — RestrictionArkansas — BanCalifornia — No banColorado — No banConnecticut — No banDelaware — No banDistrict of Columbia — No banFlorida — BanGeorgia — RestrictionHawaii — No banIdaho — BanIllinois — No banIndiana — BanIowa — BanKentucky — BanLouisiana — BanMaine — No banMaryland — No banMassachusetts — No banMinnesota — No banMississippi — BanMissouri — BanNebraska — RestrictionNevada — No banNew Hampshire — BanNew Mexico — No banNew York — No banNorth Carolina — BanNorth Dakota — BanOhio — BanOklahoma — BanOregon — No banRhode Island — No banSouth Carolina — BanSouth Dakota — BanTennessee — BanTexas — BanUtah — BanVermont — No banVirginia — No banWashington — No banWest Virginia — BanWisconsin — No banWyoming — BanKansas — Litigation-setbackMichigan — Proposed billMontana — Litigation-setbackNew Jersey — Proposed billPennsylvania — Proposed billDistrict of Columbia — No banDC

Jump to a state

One A–Z grid: all 50 states and D.C. Color is medical status. Full sourced cards are on the hub.

Alabama has banned puberty blockers, opposite-sex hormones, and surgeries for minors.

Alabama AL

MedicalBanSchoolsSchools restriction

Schools: HB322 (2022) limits classroom instruction on sexual orientation or gender identity in K–5 and requires multiple-occupancy restrooms and changing areas by biological sex. Separate from the medical ban.

Official sources

No official pediatric medical policy listed. Alaska has no statewide ban and no statewide shield law.

Alaska AK

MedicalNo ban
Official sources

Arkansas banned puberty blockers, opposite-sex hormones, and surgeries for minors. A court paused it; a higher court put the ban back in force.

Arkansas AR

MedicalBan
Official sources

California has no statewide ban. California also has a shield law.

California CA

MedicalNo ban

Plaintiff in the 2 September 2026 CMS funding suit.

Official sources

No official pediatric medical policy listed. Colorado has no statewide ban. Colorado also has a shield law.

Colorado CO

MedicalNo ban

Plaintiff in the 2 September 2026 CMS funding suit.

Official sources

No official pediatric medical policy listed. Delaware has no statewide ban. Delaware also has a governor’s order that works like a shield law.

Delaware DE

MedicalNo ban

Plaintiff in the 2 September 2026 CMS funding suit.

Official sources

No official pediatric medical policy listed. D.C. is not a state. There is no ban. Local rules work like a shield law.

District of Columbia DC

MedicalNo ban

Plaintiff in the 2 September 2026 CMS funding suit.

Official sources

Florida has banned puberty blockers, opposite-sex hormones, and surgeries for minors.

Florida FL

MedicalBanSchoolsSchools ban

Schools: Florida law restricts classroom instruction on gender identity and sexual orientation. HB 1557 barred it in K–3; HB 1069 extended the statute through grade 8. Board Rule 6A-10.081 goes further: educators shall not intentionally provide that instruction in preK–grade 8 (narrow exceptions), and in grades 9–12 unless it is required by state academic standards or is part of reproductive health with a parent’s written consent. That is a near K–12 classroom bar via the board rule, not a Texas-style zero-exception PreK–12 statute.

Official sources

Hawaii has no statewide ban. Hawaii also has a shield law.

Hawaii HI

MedicalNo ban

Plaintiff in the 2 September 2026 CMS funding suit.

Official sources

Idaho has banned puberty blockers, opposite-sex hormones, and surgeries for minors.

Idaho ID

MedicalBan
Official sources

Illinois has no statewide ban. Illinois also has a shield law.

Illinois IL

MedicalNo ban

Plaintiff in the 2 September 2026 CMS funding suit.

Official sources

Indiana has banned puberty blockers, opposite-sex hormones, and surgeries for minors.

Indiana IN

MedicalBanSchoolsSchools restriction

Schools: HEA 1608 (2023): no human-sexuality instruction before grade 4; schools must notify a parent within five business days if an unemancipated student asks to change name or pronouns.

Official sources

Iowa has banned puberty blockers, opposite-sex hormones, and surgeries for minors.

Iowa IA

MedicalBanSchoolsSchools mixed

Schools: SF496 (2023) barred K–6 gender-identity and sexual-orientation instruction and added parental-notification rules. A federal district order in May 2025 narrowed “program/promotion” language and most notification text; the K–6 mandatory-instruction bar still stands. Written rule, court narrowing — Schools mixed.

Official sources

Kansas passed a ban. A court blocked it. The statute is on the books; it is not enforced.

Kansas KS

MedicalLitigation-setback
Official sources

Kentucky has banned puberty blockers, opposite-sex hormones, and surgeries for minors.

Kentucky KY

MedicalBanSchoolsSchools restriction

Schools: The same SB150 also rewrote KRS 158.1415: no human-sexuality instruction in grade 5 and below; no instruction whose purpose is exploring gender identity, gender expression, or sexual orientation; parental consent from grade 6.

Official sources

Maine has no statewide ban. Maine also has a shield law.

Maine ME

MedicalNo ban

Plaintiff in the 2 September 2026 CMS funding suit.

Official sources

Maryland has no statewide ban. Maryland also has a shield law.

Maryland MD

MedicalNo ban

Plaintiff in the 2 September 2026 CMS funding suit.

Official sources

No official pediatric medical policy listed. Massachusetts has no statewide ban. Massachusetts also has a shield law.

Massachusetts MA

MedicalNo ban

Plaintiff in the 2 September 2026 CMS funding suit.

Official sources

Minnesota has no statewide ban. Minnesota also has a shield law.

Minnesota MN

MedicalNo ban

Plaintiff in the 2 September 2026 CMS funding suit.

Official sources

Missouri has banned puberty blockers, opposite-sex hormones, and surgeries for minors.

Missouri MO

MedicalBan
Official sources

No official pediatric medical policy listed. Nevada has no statewide ban and no statewide shield law. A 2023 shield bill was vetoed, so Nevada is not a shield state.

Nevada NV

MedicalNo ban

Plaintiff in the 2 September 2026 CMS funding suit.

Official sources

No official pediatric medical policy listed. New Mexico has no statewide ban. New Mexico also has a shield law.

New Mexico NM

MedicalNo ban
Official sources

North Carolina has banned puberty blockers, opposite-sex hormones, and surgeries for minors.

North Carolina NC

MedicalBanSchoolsSchools restriction

Schools: SL 2023-106 (SB 49), Parents’ Bill of Rights: no gender-identity, sexual-activity, or sexuality curriculum in K–4, except answers to student-initiated questions.

Official sources

Ohio has banned puberty blockers, opposite-sex hormones, and surgeries for minors.

Ohio OH

MedicalBanSchoolsSchools restriction

Schools: HB8 (Parents’ Bill of Rights, effective 2025): parental notice and opt-out for “sexuality content,” including gender ideology, and notice if a student asks to identify as a gender different from biological sex.

Official sources

Oregon has no statewide ban. Oregon also has a shield law.

Oregon OR

MedicalNo ban

Plaintiff in the 2 September 2026 CMS funding suit.

Official sources

No official pediatric medical policy listed. Rhode Island has no statewide ban. Rhode Island also has a shield law.

Rhode Island RI

MedicalNo ban

Plaintiff in the 2 September 2026 CMS funding suit.

Official sources

Tennessee has banned puberty blockers, opposite-sex hormones, and surgeries for minors. The Supreme Court said that ban may stand.

Tennessee TN

MedicalBanSchoolsSchools restriction

Schools: Tenn. Code §49-6-1308 (SB1443 / Public Chapter 353, 2023): 30-day notice and written parental opt-in before sexual-orientation or gender-identity curriculum. Separate from the medical ban (SB1 / Skrmetti).

Official sources

Texas has banned puberty blockers, opposite-sex hormones, and surgeries for minors.

Texas TX

MedicalBanSchoolsSchools ban

Schools: SB12 (89th, effective 2025–26) added Education Code §28.0043: no PreK–12 instruction, guidance, activities, or programming regarding sexual orientation or gender identity. Separate from the medical ban (SB14).

Official sources

Utah has banned puberty blockers, opposite-sex hormones, and surgeries for minors.

Utah UT

MedicalBan
Official sources

Vermont has no statewide ban. Vermont also has a shield law.

Vermont VT

MedicalNo ban

Plaintiff in the 2 September 2026 CMS funding suit.

Official sources

Washington has no statewide ban. Washington also has a shield law.

Washington WA

MedicalNo ban

Plaintiff in the 2 September 2026 CMS funding suit.

Official sources

No official pediatric medical policy listed. Wisconsin has no statewide ban and no statewide shield law.

Wisconsin WI

MedicalNo ban

Plaintiff in the 2 September 2026 CMS funding suit.

Official sources

Federal record

There is no nationwide ban. The country is split. The Supreme Court said states may protect children. Twenty-two states have a ban in force. Three have a narrower restriction. Two have a statute a court blocked. The rest have no statewide medical ban.

Supreme Court. On 18 June 2025, United States v. Skrmetti, 6–3. The Court upheld Tennessee’s ban on puberty blockers, opposite-sex hormones, and surgeries for minors. Official opinion (PDF). That is the green light for states.

The evidence. HHS published Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices. Weak evidence. Inadequate informed consent. No reliable proof these drugs and surgeries fix mental health. Official HHS review.

The money — FINAL. CMS published the final Medicaid and CHIP (Children’s Health Insurance Program) rule ending federal funding for what HHS calls “sex-rejecting procedures” on children — puberty blockers, opposite-sex hormones, and surgeries. Effective 13 October 2026. Federal Register. This is a Medicaid and CHIP funding cutoff.

DOJ hospital deals. Texas Children’s, Cleveland Clinic, Connecticut Children’s, Mount Sinai and others signed resolutions to stop the procedures on minors. DOJ’s own releases say the claims resolved are allegations only, there has been no determination of liability, and the hospitals denied the allegations.

The states — medical. The hub lists all 50 states and D.C. Ban means an enacted medical prohibition is in force — 22 states, including Arkansas after the Eighth Circuit reversed the district-court stay. Three limits are restrictions, not full bans: Arizona (surgery only), Georgia (hormones and surgeries, not puberty blockers; HB 54 died), Nebraska (surgeries banned under 19; new blockers and hormones require 40 hours of therapy, consent, and a 7-day wait). Litigation-setback is Kansas and Montana — statutes on the books, courts blocking them today. No strikethrough. No ban is the rest: no statewide medical ban. Clinic facts sit on the state card when a named source documents them. Some of those states also have a shield law — it protects access, blocks out-of-state interference, and shields providers and patients. The map and badge still say No ban. California, Oregon, New Jersey, and Washington are No ban with official shield statutes. They are not omitted, and they are not Ban.

The states — schools. Curriculum and parental-rights laws sit on a second badge on the states that have one. Listed with an official URL: Florida HB 1069 (statute through grade 8; lineage from HB 1557) and Board of Education Rule 6A-10.081 (Principles of Professional Conduct — near K–12 classroom bar, with limited 9–12 exceptions); Texas SB12 (89R) / Education Code §28.0043; Tennessee §49-6-1308 (SB1443 / Public Chapter 353 — parental opt-in for sexual-orientation or gender-identity curriculum); Alabama HB322; Indiana HB 1608; Kentucky SB150 school sections; North Carolina SL 2023-106; Ohio HB8; Iowa SF496, later narrowed in federal court — Schools mixed.

Twenty-one states, Pennsylvania’s governor, and D.C. sued on 2 September 2026 to keep Medicaid and CHIP paying. That suit has not blocked the final rule.

Puerto Rico — territory. Ley 63-2025 (16 July 2025) forbids puberty blockers, opposite-sex hormones, and surgeries to treat gender dysphoria in anyone under 21. That card sits in the Americas.

Skrmetti plus a funding cutoff is how you starve a medical scandal without pretending Congress already banned it everywhere.

Federal Register — CMS Medicaid/CHIP final rule →

World Progress →

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