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Finding your place: A guide to transgender safe havens in 2024

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In response to the growing legislative attack against transgender healthcare, some states are establishing “shield” laws to protect those fleeing their states solely for proper medical care.

Last year, the LGBTQ community faced its biggest legislative challenge yet, with around 600 bills introduced on the floor across the country aimed to bar and eradicate the community’s rights. The bills mainly aimed at the trans community, upholding legal markers over chosen ones, and banning sports participation, bathroom access, and, especially, gender-affirming care for trans youth. About 87 of the bills against the trans community passed.

Texas, Oklahoma and Missouri were the top three states with the greatest number of anti-trans bills introduced, all of which passed laws limiting gender-affirming care.

This year’s number of anti-LGBTQ legislation is creeping up to break an even greater record with already over 540 bills within less than four months into the year. As a direct result of the wave of anti-trans legislation alone, nearly one in three young LGBTQ people reported poor mental health, according to The Trevor Project report from last year.

Given that nearly all who pursue gender-affirming care feel an improvement in quality of life, according to a 2022 “Early Insights” survey by advocacy org National Center for Transgender Equality (NCTE), pro-LGBTQ states are declaring themselves safe havens for trans residents of conservative states who seek out-of-state medical care.

Safe haven states have “shield” or “refuge” laws that, although the language varies each state, strive to protect trans people from their limited access to trans health care without legal repercussions, according to Movement Advancement Project (MAP), a nonprofit think tank that has broken down gender-affirming care analysis state by state.

“For example, if a person travels from a state where transgender healthcare is banned and receives that care in another state, a “shield” law can protect the recipient and/or provider of that healthcare against civil or criminal charges from the state where healthcare is banned,” MAP explains on their “shield” law breakdown map.

In total, there are about twelve states and D.C. that have moved towards safe havens for trans healthcare, according to Reckon’s reporting.

As states continue to pass harmful laws limiting gender-affirming healthcare, it’s more important than ever to know where to turn. Here’s a breakdown of states prioritizing bodily autonomy and trans lives and how they’re doing it:

Governors can establish statewide protections by issuing executive orders declaring their state a sanctuary for gender-affirming care, sending a strong signal of support for trans rights.

There are three states that issued an executive order for sanctuary state status. Over the course of last year, Maryland, New Jersey and New York had executive orders issued to declare themselves a sanctuary state that is safe and accessible. In light of many states publicly demoralizing and demonizing gender-affirming care, states issuing executive orders shows what pro-LGBTQ states can look like despite the ongoing vulnerability of the community.

Within the first week of Pride month last year, Maryland’s Gov. Wes Moore signed Executive Order 01.01.2023.08 to protect trans healthcare amidst the slew of anti-trans bills. Earlier last April, New Jersey had issued Executive Order 326 for the same reason. While the state of New York itself is not a sanctuary state, New York City’s Mayor Eric Adams declared the city to be a sanctuary state last summer—also a response to the legislative attacks nationwide.

“This executive order reaffirms the fact that hate has no place in our city and that all people deserve the right to gender-affirming care and protection against prosecution for being who they are,” Adams said in a written statement. “To LGBTQ+ people across the nation feeling hurt, isolated, or threatened, we have a clear message for you: New York City has and will always be a welcoming home for you.”

These types of laws prevent law enforcement and government officials in safe haven states from aiding investigations initiated by states targeting those who provide or receive gender-affirming care. This offers protection from subpoenas, extradition attempts, and other legal actions.

According to Reckon’s reporting, there are two states and D.C. that uphold protections against interstate investigations, including Connecticut and New Mexico.

D.C., while not a state, also has protections against interstate meddling. Under D.C. Law 24-307, a doctor within the D.C. area who provides gender-affirming care to a trans patient who lives in a state where such care is banned, will be protected from disciplinary measures.

Meanwhile, Connecticut’s 2022 “shield” law, House Bill 5414, declared that unless the individual violates a Connecticut law, no government or law enforcement official is permitted to conduct interstate investigations into those who sought abortion-related care. Days later, “gender dysphoria” was added to the bill.

Similarly, under New Mexico’s Senate Bill 13 and House Bill 7, providers and patients are protected from civil or criminal liability for abortion or gender-affirming care in the state.

“New Mexicans in every corner of our state deserve protections for their bodily autonomy and right to health care,” said the state’s Gov. Michelle Lujan Grisham in a press release in March of last year.

These types of laws help protect transgender individuals fleeing from states where gender-affirming care is criminalized. These laws also protect the healthcare providers offering such care from possible civil or criminal charges initiated by the states where the care is banned.

There are currently around seven states that enacted “refuge” or “shield” laws, as of date of publication.

California blazed a trail, becoming the first state to declare itself a sanctuary state for trans youth back in 2022. Signed by Gov. Gavin Newsom in September of 2022, Senate Bill 107 allows trans youth from other states to receive gender-affirming care all the while alleviating families from child abuse allegations or from being criminally prosecuted for pursuing such care.

Just last week, Colorado’s Democratic Gov. Jared Polis signed a trio of bills protecting reproductive justice rights and gender-affirming services in Senate Bill 23-188, allowing those from states with restrictive laws who are seeking access to abortion and gender-affirming treatment to receive care safely.

Illinois Gov. JB Pritzker signed sweeping reproductive rights protections into law last year under House Bill 4664, which protects both patients and the health care providers from out-of-state legal action. “A medical decision should be made between a patient and their doctor—no one else,” said Gov. Pritzker in a press release in January of last year.

Oregon, Vermont and Washington are also amongst the states with “shield” laws.

Today, “shield” laws are still going strong, with lawmakers in Maine and Gov. Janet Mills approving one for gender-affirming care earlier this month under LD 227. Yesterday, senior director of civil rights and legal strategies at GLBTQ Legal Advocates & Defenders (GLAD) released a statement regarding the “shield” law, which also protects those affected by reproductive justice.

“We’re grateful to […] all the legislators who focused on the need to protect our health care providers in Maine and who persisted despite the disinformation and intimidation used to try to stop this critical legislation.”


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