On May 26, Jack Franklin woke up expecting an ordinary spring morning. He walked down the stairs of his parents’ Oklahoma City home and struck up a conversation with his mom before she headed off to work at OU Health.
That’s when he learned he lost access to gender-affirming care.
“She was like, ‘I really hate to be the person to tell you this, but I don't think we provide healthcare for you anymore,’” Franklin said.
Franklin, 25, goes by any pronouns, but he/him is most commonly used. He started gender-affirming hormone therapy in December. He said the road to understanding how he feels about himself has been long and winding.
“But as I went to therapy and I started to figure out what I actually want from my body, I became increasingly confident that this was the right choice,” Franklin said.
Franklin said his mental health and quality of life have significantly improved – something recent studies back up for many adults seeking gender-affirming care. But his healthcare was quickly interrupted by a new state law, which went into effect after the governor signed it May 12.
Senate Bill 904 was one of several measures introduced this session focusing on restricting gender-affirming care. It prevents the state Medicaid program, or SoonerCare, from covering it, and bars public funds from being used to provide or subsidize it. State property, facilities and buildings also can’t be used to deliver this care.
With the stroke of a pen, Franklin could no longer see his endocrinologist at OU Health. The academic health system also sent an email to its employees stating that it must cease coverage of gender-affirming care under its health plan as of May 12. Franklin is still on his parents’ insurance, meaning this memo applies to him.
“I sort of counted out how many pills I had left, and how much time I had,” Franklin said. “But my top priority was figuring out not only how do I get access, but how do the people I know who also need this get access.”
Law and policy experts say a slew of federal directives and court decisions targeting access are emboldening red states like Oklahoma to impose harsher restrictions. Transgender Oklahomans and the already-limited providers offering gender-affirming care in the state are now being forced to adapt to the new policy with little time to prepare.
How is the measure being interpreted?
SB 904 was filed during last year’s legislative session as a measure establishing criteria for incentive payments to contracted Medicaid long-term care providers. Sen. Todd Gollihare, R-Kellyville, submitted an amendment in March to replace the language with his bill on gender-affirming care.
Affected services include surgical procedures to alter or remove physical or anatomical characteristics “that are typical for the individual’s biological sex” and drugs used to suppress or delay puberty, or to promote the development of feminizing or masculinizing features “consistent with the opposite biological sex.”
Exclusions apply to things like behavioral health services and depression or anxiety medications, and individuals with differences in sex development. People who violate the law can be charged with a misdemeanor.
Gollihare and co-author Rep. Erick Harris, R-Edmond, declined an interview with StateImpact. But, in a statement, Harris called SB 904 “a commonsense measure.”
“Oklahoma taxpayers should not be forced to fund controversial gender transition procedures,” Harris said. “The bill keeps our state government focused on fiscal responsibility and limited government while reflecting the values of the people we represent.”
An Oklahoma Health Care Authority spokesperson told StateImpact the state Medicaid agency is now operating under SB 904. It sent a message to all providers alerting them of the changes.
OU Health did not respond to specific questions from StateImpact, but in a statement said it adheres to all rules and regulations set by the regulatory bodies that oversee it and remains “fully compliant with all state and federal laws.”
ACLU of Oklahoma legal director Megan Lambert said OU Health is likely responding to the law’s broad language on public funding and state property. The state’s fully integrated academic health system, for example, receives appropriations through the University Hospitals Authority. The agency serves as a conduit for appropriations for several entities.
She said lawmakers were careful to define public funds, which include state funds from any source, such as appropriations, apportionments, or revenue generated by state agencies through fines, fees, or other means. SB 904 says those funds can’t be used, granted, paid or distributed to any entity, organization or individual for the provision or subsidy of gender-affirming care.
Lambert said the law did not build in any time for state facilities to digest the language and implement any necessary changes, leading to potential over-compliance in areas of uncertainty.
“Folks, one, are really hesitant to try to separate funding streams when any kind of commingling of those funds can result in a criminal misdemeanor,” Lambert said. “But then that becomes even more practically difficult and potentially impossible when you are also facing the prohibition of using state property. And that was intentional.”
Rep. Ellen Pogemiller, D-Oklahoma City, said she received emails from Oklahomans impacted by this legislation before and after the measure passed.
“This is gender-affirming care that they have received from a physician who believes this is the best care for them, and it's none of our business as lawmakers to decide who gets to get that access to that care,” Pogemiller said.
“I think it's very concerning and alarming, and I think the impact is greater than we initially had anticipated.”
‘We're booked out for the next five weeks’
That impact is being felt in the limited spaces statewide that offer gender-affirming care. Lily Pina is the family nurse practitioner at the Oklahomans for Equality Health Clinic. The clinic is one of the newer arms of the nonprofit organization, which has served the LGBTQ+ community since the 80s.
It offers several services, including gender-affirming hormone therapy. The clinic is fully credentialed with Blue Cross Blue Shield, and its lab is credentialed with all insurances. It also accepts self-pay patients. But Medicaid is no longer an option.
LGBTQ+ adults are twice as likely as non-LGBTQ+ adults to rely on Medicaid as their primary health insurance source.
“We've definitely had an influx of patients needing to transfer their care because their current provider couldn't continue to provide their transgender services,” Pina said June 3. “So, as of right now, we're booked out for the next five weeks.”
Hailey Briggs, the executive director of Oklahomans for Equality, added that OU was quick to reach out the day after the legislation passed to ensure its patients could continue to access care.
Briggs said the “intentionally vague” language has left a lot up to interpretation for providers.
“There are a lot of medical institutions that are publicly funded in some way, and so how those institutions are interpreting this legislation has a big impact on who we're seeing,” Briggs said.
Oklahomans for Equality currently has a fundraising campaign to support patient assistance and is working to stretch its resources to serve more people.
“Unfortunately, what this means is we're trying to fit folks in with as little disruption to their care as possible,” Briggs said. "But it's a real challenge."
Planned Parenthood health centers in the state already can’t accept Medicaid following an executive order from Gov. Kevin Stitt last year. The centers accept most insurance plans and offer self-pay. Patients can access providers in person and virtually.
Planned Parenthood Great Plains President and CEO Emily Wales said some Medicaid patients have stayed with them despite having to pay out of pocket, though they do have some private funds to support their care. But she said it’s difficult to cover everyone.
“It's a hard thing to know that we have capacity and supporters who want us to see these patients and patients who want to see us,” Wales said.
She said patients affected by SB 904 may experience some delay in in-person care, but they are doing everything they can to increase appointment availability, especially through telehealth.
“My expectation is that many patients who were relying on Medicaid are going to have to turn to private funding, and think about whether they can stay in Oklahoma long-term to be their healthy, authentic self, or if they're going to have to flee the state to access care,” Wales said.
Federal actions reinforce state restrictions
Several federal actions are emboldening red states like Oklahoma to restrict gender-affirming care further, said Katie Keith, director of the Center for Health Policy and the Law at Georgetown Law.
One is the 2025 Supreme Court ruling in U.S. vs. Skrmetti, which allowed Tennessee to maintain its gender-affirming care ban for minors.
Three families and a physician argued the law violates the equal protection clause and discriminates on the basis of sex. But the court found the law doesn’t warrant heightened scrutiny, saying its restrictions are based on age and medical use.
Keith said the ruling suggested the state had more flexibility to regulate gender-affirming care for minors. Twenty-seven states have enacted laws and policies limiting youth access to gender-affirming care.
Oklahoma became one of them in 2023 when it passed Senate Bill 613, banning gender-affirming care for people under 18. The ACLU of Oklahoma fought the measure alongside five families with transgender youth across the state.
The case was still ongoing, and the organization was working to stop the state from enforcing the law while they continued to litigate. But after Skrmetti, a U.S. appeals court said they were not entitled to a preliminary injunction.
“Their argument was so strongly against many of the arguments that we put before them that we simply didn't see a viable path to litigation moving forward,” Lambert said. “So, we voluntarily dismissed.”
A U.S. appeals court also recently used Skrmetti’s reasoning to uphold West Virginia’s ban on Medicaid coverage for adult gender-affirming surgeries.
President Donald Trump has also issued several executive orders disputing the concept of gender identity and directing agencies and programs to work on limiting gender-affirming care for minors.
U.S. Health Secretary Robert F. Kennedy Jr. issued a declaration stating gender-affirming care procedures aren’t safe or effective for treating gender dysphoria in young people. It also stated the Secretary may exclude individuals or entities from participating in any federal healthcare program if the Secretary determines they delivered services that failed “to meet professionally recognized standards of healthcare.”
A federal district court in Oregon vacated the declaration in April.
The declaration was issued on the same day as two proposed rules that would prohibit federally funded hospitals from offering gender-affirming care to minors and prevent Medicaid and Children’s Health Insurance Program funds from covering this care.
Keith said she’s waiting to see whether these rules will be finalized or if the Department of Justice will appeal the case filed by Oregon.
“I do think there is an overarching goal to try to stop the care, regardless of age,” Keith said. “It just feels to me like they're starting with young people.”
An uncertain future
About a month after SB 904 went into effect, Franklin got in for an appointment at a private clinic to continue his gender-affirming hormone therapy. His medication was only interrupted for a few days.
He decided to switch to an intramuscular injection and got to administer the medication for the first time on June 10. He was a bit nervous about the needle, but overall felt good about his new provider and the care he's receiving.
“In terms, strictly, of my healthcare, I feel a lot better. I'm glad that I have a path forward,” Franklin said. “In terms of legislation and financials, I could be better.”
His insurance worked at his appointment in June, but the communication he received from OU Health says coverage changes are effective May 12. He’s spent much of his free time trying to get answers since he learned he was impacted by SB 904. But he hasn’t had much luck so far.
He’s waiting to see what happens next and whether he will owe the remaining costs for his appointment and medication.
Franklin plans to move to Salt Lake City with his sister at the end of the year. Utah does have restrictions on gender-affirming care for minors but offers it to adults. Utah lawmakers also recently rejected a bill that would have banned public, taxpayer-funded insurance from paying for gender-affirming care.
He said laws like SB 904 make it easier to leave Oklahoma. But he hopes the future will be safer for him and others impacted by them.
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