While states across the country are passing bans on gender-affirming care, legislation proposed in the Maryland General Assembly would ensure those states can’t wield private health records against transgender Marylanders and their physicians.
HB0691, proposed by Silver Spring representative and House Majority Leader Del. David Moon (D-Dist. 20), would add gender-affirming care to the state’s definition of legally protected health care. It would protect Maryland residents and patients who live outside of the state who receive gender-affirming care within the state, as well as their physicians, from legal action and prosecution for receiving or providing that care.
Moon and the bill’s co-sponsors intend to stop out-of-state criminal and civil judgments, subpoenas, investigations, extraditions and warrants. If the bill passes, another state could not suspend a physician’s professional license in Maryland for providing gender-affirming care.
“We are not going to be in the business of having our states facilitate and cooperate with out-of-state prosecutions and investigations and access to our medical records,” Moon said at a hearing before the House Health and Government Operations Committee last week.
But critics of the bill say it’s not a necessary law because there have not been out-of-state inquiries about transgender health care in Maryland yet, and those opposed to gender-affirming care access say this will encourage and make it easier for people to access it.
The bill has received co-sponsorship from several other Montgomery County representatives, including Del. Lorig Charkoudian (D-Dist. 20), Del. Bonnie Cullison (D-Dist.19), Del. Anne Kaiser (D-Dist. 14), Del. Aaron Kaufman (D-Dist. 18), Del. Lesley Lopez (D-Dist. 39), Del. Bernice Mireku-North (D-Dist. 14), Del. Julie Palakovich Carr (D-Dist. 17), Del. Emily Shetty (D-Dist. 18), Del. Vaughn Stewart (D-Dist. 19), Del. Joe Vogel (D-Dist. 17) and Del. Jheanelle Wilkins (D-Dist. 20).
The legislation mirrors abortion shield laws passed last year in Maryland. Moon said the bill reflects existing anti-discrimination laws.
“If we don’t pass [this bill], it would expose our residents, patients, medical providers, caregivers, and, dare I say parents and their decisions, to being overruled by politicians in other states that have come to different conclusions,” Moon said.
He emphasized that gender-affirming care can include therapy and mental health services to aid in suicide prevention for LGBTQ+ individuals.
In a March 2023 report, the U.S. Department of Health and Human Services defined gender-affirming care as “a highly specialized model of care that uses evidence-based practices to address distress arising from gender dysphoria.”
This care can vary based on the individual, but may include hormone replacement therapy, surgery and alterations to various parts of the body, voice therapy, and other healthcare intended to help align a person’s body with their gender identity.
Major medical organizations including the American Medical Association, American Academy of Pediatrics, and the American Psychological Association designate gender-affirming care as medically necessary. The federal government has named gender-affirming care as an “essential health benefit” protected under Section 1557 of the Affordable Care Act, and earlier this year, Maryland lawmakers passed the Trans Health Equity Act sponsored by Kaiser, which requires Maryland Medicaid to cover gender-affirming care for transgender residents.
Brige Dumais, an advocate with the Trans Rights Advocacy Coalition of Maryland and political coordinator with SEIU1199, a health care workers union, told MoCo360 that the feedback on the legislation from legislators and the community has been “overwhelmingly positive.”
“We for the most part seem to be on the same page that gender-affirming care is life saving and medically necessary and that our health care workers and support networks should not be penalized for providing care that’s in line with the current clinical standards of care, no matter what other states have to say about it,” Dumais said.
Dumais said the precedent for the proposed legislation has been set by laws passed in 11 states and Washington, D.C.
To demonstrate the need for the legislation, they referenced a 2023 incident in which the Texas attorney general subpoenaed physicians at Seattle Children’s Hospital for the records of trans patients.
“This is not hypothetical. It is happening. Maryland is the geographically furthest south trans sanctuary state on the East Coast, which means we are the closest place that people can come from the South to be able to have protections to receive this care,” Dumais said.
A complementary Senate bill, SB0119, sponsored by Anne Arundel and Howard County Del. Clarence Lam (D-Dist. 12), has been moving steadily through that chamber, and received favorable reports in the Senate Finance Committee.
Supporters of the House legislation during last week’s hearing said the protection is vital for Maryland to be a safe place for transgender residents.
Lee Blinder is the chair of the Maryland Commission on LGBTQI+ Affairs and the founder of Trans Maryland, an organization that advocates for transgender residents and helps them find gender-affirming care and file legal paperwork. Blinder started the organization after they struggled to find gender-affirming care in Montgomery County.
“In the past year, we at Trans Maryland have seen a sharp rise in new Marylanders who are seeking our services, Marylanders who are fleeing the … states that have targeted this community,” Blinder said during the hearing. “This simple technical fix to our reproductive health act will ensure transgender Marylanders have the full protections of government from outside states that are actively attempting to impose their discriminatory laws, which threaten our very lives.”
Del. Brian Chisholm (R-Dist. 31), who represents Anne Arundel County, voiced skepticism that the legislation was necessary. He said it seemed like “putting the chicken before the egg,” and that laws regarding transgender healthcare seemed like a recent movement.
“I understand and I respect and admire the move to try to keep records private,” Chisholm said. “I just can’t see another state going after somebody that came to Maryland and had surgery in the state.”
Some speakers in opposition to the legislation said they were worried the bill would make it easier for minors to access gender-affirming care.
“It’s wrong that Maryland allows gender transition surgery for minors, but it’s double wrong that this bill makes it nearly impossible for a child to have a remedy for any doctor in the state using a lawsuit from a different state,” said Bob Nelson, a Maryland Family Institute board member. The Maryland Family Institute is a conservative faith-based organization that lobbies for and against policy in Annapolis.
Dumais said they think people who oppose the bill don’t understand what the legislation would do: It doesn’t make any changes to the laws regarding who can legally receive gender-affirming care. It only addresses legal privacy.
“I think a lot of the opposition testimony was focused on things that the bill does not do. People still have the right to file malpractice claims,” Dumais said. “Parents still need to consent for the vast majority of gender-affirming care [for youth]; there are only extremely limited areas where that would not be required.”
Matt Dudzic, a spokesperson for the Maryland Board of Physicians, said the organization supports the legislation, and confirmed it would not preclude a patient from filing a malpractice complaint.
“HB0691 does not in any way limit our ability to take action against inappropriate medical care, including in the sphere of gender-affirming treatment. All medical care in Maryland must be appropriate and must meet the necessary standard of care,” Dudzic said. “Unfortunately, care that is considered safe and appropriate both here in Maryland and throughout the medical community at large is under attack in other states.”
The expansion of gender-affirming care has become a hot topic in Montgomery County after Gov. Wes Moore (D) declared Maryland a sanctuary state for transgender health care access in June, making it the 11th state to do so alongside the District California was the first, with Colorado, Connecticut, Illinois, Massachusetts, Minnesota, New Jersey, New Mexico, Vermont and Washington state following.
HB0691 is part of the larger effort for Maryland to be a true sanctuary state for transgender people and their families when it comes to policy from LGBTQ advocates and local legislators. This effort can be seen on the county level as well.,
A Jan. 16 report by the Montgomery County Office of Legislative Oversight commissioned by County Council Vice President Kate Stewart (D-Dist. 4) found that the county government could be doing more to support its transgender residents. It recommended officials consider creating a resource center and lobbying the state to require cultural competency training for medical providers.
A county survey released in October 2023 revealed that more than 41% of trans and gender expansive county residents faced difficulty finding gender-affirming care and gender-affirming mental health support.
“While we’re a very progressive place and we’re trying to be a welcoming place for LGBTQ+ families, the report itself says we are a desert when it comes to these types of health services,” Stewart told MoCo360 in November. “We need to get behind these services and need to be doing much better.”