KY Dept. of Corrections amends LGBT-inclusive rules, continues providing hormone therapy
On the heels of a legal opinion from Kentucky’s Republican attorney general, the state’s Department of Corrections is scaling back new protocol that initially provided greater accommodations for transgender inmates.
The new rules, which are still being drafted, will not allow the corrections department to fund surgical interventions for trans people in state custody, as the prior proposed rules potentially would have.
But the new rules won’t prevent the department from dispensing gender-affirming medication, like hormones, to trans inmates if it’s doctor-recommended, an attorney with the Justice and Public Safety Cabinet told the Government Contract Review Committee on Monday.
Aspects of the regulations in question, which act as official policy and procedural guidelines for corrections staff in Kentucky’s jails and prisons, took effect in 2023. Other parts were proposed as recently as May 2024. They define what it means to be intersex and transgender and advise staff on how to respond to the unique needs of this marginalized population when they are incarcerated.
Accommodating those needs does not always but may involve connecting those inmates with health care providers to receive gender-affirming medical care. Kentucky’s proposed rules are in line with federal standards under the Biden administration. Even during the first term of President-elect Donald Trump, the Bureau of Prisons provided gender-affirming care to trans prisoners.
But those regulations drew sharp ire from Republicans last month, which in turn helped to spur the department to ask Kentucky Attorney General Russel Coleman whether or not the state is required by federal law to pay for trans inmates’ gender-affirming surgery.
On social media and at the Government Contract Review Committee’s Dec. 9 meeting, Republican members were quick to criticize new rules that, for example, ensured trans inmates have access to appropriate medical and mental health services and are housed in facilities that align with their gender identity. And if a trans inmate requests gender-affirming care, the changes laid out the protocol for staff to meet that request, including extensive mental health evaluations and potentially medical interventions.
“It doesn’t get much more radical left and extreme than this,” the Republican Party of Kentucky posted on X at the time.
The Department of Corrections responded by saying it was waiting for Coleman’s legal opinion before implementing new changes. Coleman said on Dec. 19 the department is not required to fund such surgeries, calling any suggestion otherwise “simply absurd.”
In response to this opinion, the department nixed that portion of the rules and is temporarily abiding by 2018-era protocol while new language in compliance with the Prison Rape Elimination Act is drafted, Leah Boggs, general counsel for the Justice and Public Safety Cabinet, told the Government Contract Review Committee during its Monday meeting.
The DOC has not provided any inmate with gender-affirming surgery while in custody.
“I don’t want to parse words: no gender-affirming surgery has happened, did happen or will happen,” Boggs told committee members.
But the DOC will continue providing — and funding — hormone replacement therapy to trans inmates if it’s doctor-recommended, Boggs said, just as the department does for all other medications.
“Inmates have received hormone therapy for years,” she said. “Whether hormone therapy is provided has not changed, but we have never approved or provided gender-reassignment surgery.”
As of Jan. 8, 12,842 people were in state custody. Of those inmates, 467 were receiving hormone therapy for a variety of reasons, like menopause or post-partum depression. Sixty-seven of that 467 — 0.5% of the total incarcerated population — were receiving prescription hormone therapy for gender dysphoria, which is when a person’s gender identity doesn’t match their sex assigned at birth, Boggs said.
The department pays for all prescriptions through a contract it maintains with a pharmacy, which provides all medication for its jail and prison populations, including the 67 trans inmates receiving hormone therapy. And that won’t change, even under the new rules, Boggs said.
With the new regulation drafted by the department, “will that change that policy or will that continue?” committee chairman Sen. Stephen West, R-Paris, asked Boggs.
“That will continue,” because hormone therapy is prescribed for a “medical need,” and the department provides “drugs for all inmates for all medical needs,” she said.
Inmates are only prescribed hormone therapy after consultation with their physician — and, in the case of trans patients, after consulting an independent endocrinologist. If it’s considered a “medical need, that’s when the department would pay for it,” Boggs added.
It’s unclear whether Republicans will try to pass policy that somehow limits the dispensation of gender-affirming health care in correctional facilities, but at least one lobbying organization is urging them to do so.
Last month, the Family Foundation, a conservative Christian lobbying group, derided the department policy, urging the Republican-controlled General Assembly to “take quick action to end this disgraceful use of taxpayer dollars . . . and to push back against the Beshear administration’s overreach more broadly.”
At the Monday legislative committee meeting, Sen. David Yates, D-Louisville, warned against using ideology to dictate how corrections dispenses health care to inmates.
“We get into dangerous territory whenever states, or even the DOC, would try to make the determination of which medicine they’re going to supply to inmates based on their own belief of what’s reasonable and necessary,” Yates said.
Boggs agreed.
“Absolutely, we would not substitute our decision for a doctor that says treatment is reasonably, medically necessary,” she said.
