Missouri Judge Halts Restrictions on Gender-Affirming Care for Trans Adults and Youth

By Devan Cole, CNN

(CNN) -- A state judge in Missouri temporarily blocked the state's limits on gender-affirming care for minors and adults in the state on Wednesday, putting them on hold just hours before they were set to go into effect.

In a brief order from St. Louis County Circuit Judge Ellen Ribaudo, the court essentially bought itself more time to consider whether it should issue emergency relief in a lawsuit seeking to strike down the restrictions.

Ribaudo said she would issue a decision on the plaintiff's motion for a temporary restraining order by next Monday, saying she wanted more time to review briefs that will be submitted by Republican Attorney General Andrew Bailey, who issued the new restrictions.

"The Attorney General has not yet filed their brief in opposition, which the court would like to review," the order read.

A number of GOP-led states have in recent years enacted bans on such care for minors, but Missouri's rules represented the first time a state has attempted to impose such restrictions on trans adults.

The restrictions were set to go into effect on Thursday, but Ribaudo's order means that, for now, some of the nation's most wide-reaching limits on gender-affirming care will be paused for at least several days.

"We're glad that the court is taking this seriously and we hope that the rule will be enjoined after she considers all the evidence in front of her," said Gillian Wilcox, an attorney with the American Civil Liberties Union of Missouri, which is providing representation to the plaintiffs in the case.

Gender-affirming care is medically necessary, evidence-based care that uses a multidisciplinary approach to help a person transition from their assigned gender -- the one the person was designated at birth -- to their affirmed gender, the gender by which one wants to be known.

The "emergency rule" issued earlier this month by Bailey claims people often take "life-altering interventions," like pubertal suppression or gender transition surgery, "without any talk therapy at all," and that the emergency action is "needed because of a compelling governmental interest and a need to protect the public health, safety, and welfare" of Missourians.

Among other stipulations, the rule says it's "unlawful" for individuals or health care providers to provide gender-affirming care without confirming that a patient has "for at least the 3 most recent consecutive years ... exhibited a medically documented, long-lasting, persistent and intense pattern of gender dysphoria."

If allowed to go into effect, the rule would expire February 6, 2024, according to a release from Bailey's office.

"This order merely stays the implementation of our rule so the Court can review the briefing. We will continue fighting for all patients to have access to adequate health care," said Madeline Sieren, a spokesperson for Bailey's office, in a statement.

The lawsuit was brought Monday by a transgender adult in the state, two trans youth there, a St. Louis center that providers treatment for gender dysphoria and a social worker in the city who "provides individual therapy and assistance with gender care needs," according to court documents.

Lawyers for the plaintiffs argued in their complaint that Bailey, who relied on a state consumer protection law to issue his emergency rule, exceeded his authority in doing so and did not properly follow the state's rulemaking process.

"The Emergency Rule is an improper, extra-legislative overreach by an un-elected political appointee, who purports to distort and weaponize the MMPA, an act purposed on making sure that cars are sold with titles and that hardware stores abide by a warranty on a vacuum, in order to dictate what medical care is available to adults Missourians," they wrote in court papers.

"A temporary restraining order preserving the status quo and staying the effectiveness of the Emergency Rule -- and prohibiting the Attorney General from enforcing it -- is needed to protect Missourians, including certain of the Plaintiffs, from the irreparable harms concomitant with limitations to and denials of clinically appropriate and medically necessary health care, and to preserve their rights and interests under the laws of the State of Missouri," they told the court.

The attorney general's office said earlier Monday that the regulation "is based on dozens of scientific studies and reports, which are cited in endnotes."

In pushing the measures for minors, lawmakers have long argued that young people should wait until adulthood to make decisions around such care. But LGBTQ advocates have stressed that the long-term goal for conservatives has been to prohibit the care for everyone, regardless of age, and several bills seeking to restrict the care for adults were introduced in statehouses around the country earlier this year, underscoring that point.

In a few rare cases, Republicans have split with their party on the issue, including in Missouri, where the state's GOP secretary of state has said he disagrees with Bailey's decision to extend the limitations to adults, but supports the restrictions for minors.

"In our country, adults have a right to make their own decisions with what they're going to do with their own money. Now if they want to use my money, if they want to require me to say that it's a right thing or a good thing that's different," John Ashcroft told CNN's Bianna Golodryga Tuesday on "The Lead."

"But if you have someone that's an adult ... they can make their own decision as to what they want to do -- I support that," he added.

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