Trans Resource Navigator

Gender-affirming care in Missouri

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  • Page changed: 2026 ballot measures (2026-10-12) · #262
Care for adults
Limited
Care for people under 18
Banned
MO HealthNet pays for hormones
Not covered
MO HealthNet pays for surgery
Not covered
Private plans must cover care
No state rule

Adults in Missouri can get hormone therapy, but MO HealthNet (Medicaid) will not pay for hormones or surgery for gender transition at any age, and state prisons may not provide gender transition surgery. For anyone under 18, Missouri bans hormones, puberty blockers, and surgery for gender transition (SB 49, upheld by the Missouri Supreme Court in January 2026). On November 3, 2026, voters decide Amendment 3, which would write the ban for minors into the state constitution.

Draft from official sources, September 24, 2026. Not yet checked by a person. How we verify

On this page
  1. If you are under 18, or a parent
  2. Rules for adults
  3. Health centers near you
  4. Hormones by telehealth
  5. Clinics, programs, and funds
  6. Paying for care
  7. Laws and court cases
  8. Sources

If you are under 18, or a parent

Since August 28, 2023, the Missouri SAFE Act (SB 49, RSMo 191.1720) bars health care providers from performing gender transition surgery on anyone under 18 and from prescribing or giving cross-sex hormones or puberty blockers for gender transition to anyone under 18.

  • Grandfather clause: young people who were already receiving hormones or blockers for gender transition before August 28, 2023 may continue.
  • Exceptions: disorders of sex development, treating complications of earlier transition care, and emergencies.
  • Penalties: a violation is unprofessional conduct and the provider's license must be revoked. Patients can sue for at least $500,000, with damages tripled, up to 15 years after turning 21.
  • Court challenge: the Missouri Supreme Court upheld the law on January 13, 2026 (E.N. v. Kehoe); it is fully in effect.
  • Sunset and ballot: the ban on hormones and blockers is written to expire on August 28, 2027; the surgery ban has no end date. Amendment 3 on the November 3, 2026 ballot would add a ban on "gender transition procedures for minors, including gender transition surgeries, cross-sex hormones or puberty-blocking drugs" to the state constitution. If it passes, the 2027 statutory sunset would no longer end the ban.

Planned Parenthood Great Rivers sends minors who want to start hormones to its Fairview Heights, Illinois health center (Illinois allows this care); its Regional Logistics Center (618-607-5080) helps with travel. The Campaign for Southern Equality keeps a guide for Missouri families.

[1][4][5][7][8]

Rules for adults

Hormone therapy is legal for adults 18 and older, and Missouri has no law limiting which providers can prescribe it. Planned Parenthood Great Rivers prescribes on an informed consent basis (no therapist letter), in St. Louis-area health centers and by telehealth, with financial assistance for those who qualify. Telehealth services FOLX and Plume also serve Missouri.

The restrictions are about money and custody:

  • MO HealthNet (Medicaid) will not pay for cross-sex hormones, puberty blockers, or gender transition surgery, for adults or minors (RSMo 208.152.15). If you rely on MO HealthNet, you will need to pay cash for these medications or use a fund.
  • State prisons may not provide gender transition surgery (RSMo 217.230).

If you have no insurance and little money:

  1. Planned Parenthood Great Rivers: financial assistance for hormone therapy; call 314-531-7526.
  2. Community health centers (find one at findahealthcenter.hrsa.gov) charge on a sliding scale; ask whether a provider manages gender-affirming hormones.
  3. Point of Pride's HRT Access Fund pays for telehealth hormone care (applications open once a year).
  4. Generic estradiol and spironolactone are usually inexpensive at cash prices with a discount coupon; ask the pharmacy for the cash price.
[2][3][7][15][16]

Community health centers near you

These federally funded centers must see you whether or not you have insurance, and charge based on income. Many, but not all, prescribe hormone therapy. Call and ask for "gender-affirming care" or "hormone therapy."

Sorting by distance uses your location only on this device. It is never sent anywhere.

Hormones by telehealth

These services prescribe hormones through video visits for people in this state. Point of Pride pays for a year and a half of care with several of them each spring.

  • Plume

    PaidNo Medicaid18+

    Trans-led telehealth service providing informed-consent hormone therapy, lab orders, prescriptions, and letters for surgery and documents, by app and video visit. Self-pay only since January 2026. A Point of Pride HRT Access Fund partner.

    About $99 per month ($90 in NY and NJ), which includes visits, messaging, prescriptions, and document letters. Labs and medications are billed separately and are often cheap with GoodRx or at a community pharmacy. Free for 18 months if you win a Point of Pride HRT Access Fund grant.

  • FOLX Health

    InsuranceTakes insuranceNo Medicaid18+

    LGBTQ-focused telehealth offering hormone therapy, PrEP, primary care, and mental health visits. Accepts major commercial insurance (Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare) but not Medicaid or Medicare. A Point of Pride HRT Access Fund partner.

    In-network with many commercial plans; self-pay membership about $69 to $98 per month all-inclusive.

  • Planned Parenthood

    Sliding scaleTakes insurance

    Many Planned Parenthood affiliates provide informed-consent gender-affirming hormone therapy alongside sexual and reproductive health care, on a sliding scale and with Medicaid. Most affiliates see adults 18 and older; a few see 16- and 17-year-olds with parental consent and a readiness letter. Many start hormone care by telehealth. Self-pay initial consults typically run about $120 to $250 before sliding-scale discounts.

Clinics, programs, and funds

Paying for care

Medicaid (MO HealthNet)[2][9]

State law says "there shall be no payments made" by MO HealthNet for gender transition surgeries, cross-sex hormones, or puberty-blocking drugs for the purpose of a gender transition (RSMo 208.152.15, added by SB 49 in 2023). This applies to adults as well as minors. MO HealthNet still covers your other care, including primary care, lab work, mental health care, PrEP, and STI testing, so it is still worth enrolling if you qualify.

Apply online through the Department of Social Services.

Apply for coverage

Private insurance[11][10][18][12]

Missouri has no state law requiring private insurers to cover gender-affirming care or forbidding exclusions. Coverage depends on your plan. If a claim is denied, appeal with the plan first, then ask for an external review; you can file a complaint with the Missouri Department of Commerce and Insurance for state-regulated plans. Employer self-funded plans are federally regulated. The Trans Health Project has free appeal templates, and LSEM's Marketplace Assistance Program helps St. Louis-area residents choose and use marketplace coverage.

File an insurance complaint

The rules in detail

Laws and court cases1 court case, 3 laws

E.N. v. Kehoe (formerly Noe v. Parson)

The ban on care for minors is fully in effect. The case is closed.[4]

Families of trans youth, medical providers, PFLAG, and GLMA challenged SB 49 under the Missouri Constitution. The trial court upheld the law in November 2024, and the Missouri Supreme Court affirmed on January 13, 2026. Last update 2026-01-13.

  • RSMo 191.1720 (SB 49, 2023), Missouri SAFE Act: Bans gender transition surgery, cross-sex hormones, and puberty blockers for gender transition under 18; hormone and blocker provisions expire August 28, 2027
  • RSMo 208.152.15: No MO HealthNet payment for gender transition surgery, cross-sex hormones, or puberty blockers
  • RSMo 217.230: Correctional health care excludes gender transition surgery

Sources

18 sources. Numbers in the text, like [1], point here.Show all
  1. RSMo 191.1720, Missouri Save Adolescents from Experimentation (SAFE) ActMissouri Revisor of Statutes, Law. accessed
    “A health care provider shall not knowingly prescribe or administer cross-sex hormones or puberty-blocking drugs for the purpose of a gender transition for any individual under eighteen years of age. ... The provisions of this subsection shall expire on August 28, 2027.”
  2. RSMo 208.152, MO HealthNet medical servicesMissouri Revisor of Statutes, Law. accessed
    “There shall be no payments made under this section for gender transition surgeries, cross-sex hormones, or puberty-blocking drugs, as such terms are defined in section 191.1720, for the purpose of a gender transition.”
  3. RSMo 217.230, health care services for correctional centersMissouri Revisor of Statutes, Law. accessed
    “which shall not include any gender transition surgery, as defined in section 191.1720”
  4. E.N. v. Kehoe (formerly Noe, et al. v. Parson, et al.)Lambda Legal, Organization. accessed
    “January 13, 2026: Missouri Supreme Court upheld SB 49, allowing the ban to remain in effect”
  5. 2026 ballot measuresMissouri Secretary of State, Official page. accessed
  6. HCS HJR 73 (2025) bill informationMissouri House of Representatives, Official page. accessed
    “Last Action: 05/30/2025 - Delivered to Secretary of State”
  7. Gender-affirming hormone therapyPlanned Parenthood Great Rivers, Organization. accessed
    “In compliance with Missouri SB 49, starting August 28, 2023, minors looking to start gender-affirming hormone therapy can no longer be seen in Missouri, but can make an appointment at our Fairview Heights, Illinois, health center.”
  8. Transgender JusticePROMO, Organization. accessed
  9. Apply for MO HealthNetMissouri Department of Social Services, Official page. accessed
  10. Insurance complaintsMissouri Department of Commerce and Insurance, Official page. accessed
  11. Missouri state profileMovement Advancement Project, Organization. accessed
  12. ServicesLegal Services of Eastern Missouri, Organization. accessed
    “Marketplace Assistance Program helping families access health insurance”
  13. Southampton HealthcareOrganization. accessed
  14. HIV Prevention and CareAffinia Healthcare, Organization. accessed
  15. Find a Health CenterHealth Resources and Services Administration, Official page. accessed
  16. HRT Access FundPoint of Pride, Organization. accessed
  17. GenderbandsOrganization. accessed
  18. Trans Health ProjectAdvocates for Trans Equality, Organization. accessed