Bill to protect ‘conversion therapy’ now also bans Medicaid funds for gender-affirming care
An amended bill that initially only sought to protect the controversial practice of conversion therapy now also proposes outlawing the use of Medicaid funds to pay for gender-affirming health care for transgender Kentucky adults.
House Bill 495 from Rep. David Hale, R-Wellington, was amended during a committee meeting Wednesday morning to ban Kentucky Medicaid program funds from paying for gender-affirming hormones or surgery for transgender adults.
This is not the first change the bill has undergone.
It initially sought to protect mental health professionals’ ability to provide conversion therapy, but was changed last week to undo Gov. Andy Beshear’s 2024 executive order that banned spending tax dollars to pay for the practice.
The language in the new section of the bill, which was provided to legislators during the meeting, bans the Kentucky Department of Medicaid Services, as well as any managed care organization that contracts with the department, from spending Medicaid funds on two items.
It bans spending on “cross-sex hormones in amounts greater than would normally be produced in a healthy person of the same age and sex,” which would ostensibly include gender-affirming medication; as well as “gender reassignment surgery” to alter “characteristics or features that are typical for and characteristics of a person’s biological sex.”
“Bans on Medicaid funding for gender-affirming care violates the Medicaid Act in multiple ways,” Chloe Atwater, an attorney with the Kentucky Equal Justice Center, told the committee. “Passing this bill will lead to litigation, I promise, in addition the great harm it would cause to the low-income trans Kentuckians I serve every day.”
Atwater added that “conversion therapy is widely condemned by leading medical organizations.”
“Allowing practices like conversion therapy to continue is contrary to the principles of liberty and personal rights,” Atwater said.
The bill does not ban talk therapy that affirms a transgender person’s gender.
The bill goes a step further than previous efforts in limiting transgender Kentuckians’ ability to get care.
Whereas 2023’s controversial Senate Bill 150 was focused on youth — that made it illegal for any trans person under age 18 from accessing gender-affirming health care — House Bill 495 applies to adults.
Senate Majority Caucus Chair Robby Mills, R-Henderson, said during the committee meeting that he doesn’t believe Medicaid pays for either cross-sex hormones or surgeries.
“I’m not a medical expert, but I think I’m right on this that Kentucky Medicaid does not cover these services currently in the (substitute bill),” Mills said.
A Herald-Leader request for clarification from the Cabinet for Health and Family Services has not yet been returned.
By also overturning Beshear’s executive order, Hale’s bill would allow the use of state and federal dollars to pay for conversion therapy — a widely discredited form of counseling that attempts to change a person’s sexual orientation, gender identity or gender expression.
Nick Spencer, director of policy for the Family Foundation and an ordained pastor, was the only person who spoke in favor of Hale’s bill Wednesday.
“Imagine you have generalized anxiety disorder, you walk into a counselor’s office and that counselor says to you, ‘I’m sorry, but I can only affirm your generalized anxiety disorder. I cannot help you overcome your generalized anxiety disorder,’” Spencer said. “Beshear’s executive order limits the free speech of counselors on the issue of gender and sexuality. It says to counselors, to pastors like myself, you can only counsel in one direction on this issue.”
“Even if you’re not a Christian, I don’t think you would like to go into a doctor’s office, presenting some sort of problem you would like to see fixed, and be told that the doctor or counselor cannot help you fix that problem because of government directives.”
Spencer said much of the criticism of conversion therapy is because “it tells somebody there is something wrong with them and they need to be fixed. (But) at its core, that’s the purpose of counseling: to help somebody fix what is broken.
“The most loving thing we can do is to turn to the one who offers the ultimate solution for their brokenness,” Spencer said before quoting the Bible.
Sen. Karen Berg, a physician and mother of a transgender activist who died in 2022, rebuked the original bill and the latest addition as needlessly cruel.
“Literally adults who know who they are, whose medical treatment almost exclusively is either a shot or a pill, and we’re going to deny them that?” Berg, a Louisville Democrat, said. “No thank you.”
Paducah Republican Sen. Danny Carroll was the only Republican to vote against the bill.
“For me, it’s looking no further than that child,” Carroll said. “The risk of it increasing suicidal rates, is it worth forcing that on a child? I don’t feel it’s my place to judge anyone. That’s our God’s place to do that.”
Carroll was the lone Senate Republican to vote against SB 150 in 2023 after his attempt to moderate a similar House bill fell apart.
This story was originally published March 12, 2025 at 11:12 AM.
