Document Type

Capstone Experience

Graduation Date

5-2024

Degree Name

Master of Public Health

Department

Health Services Research & Administration

First Committee Member

Dr. Kaitlyn Crosby, PhD, MHA

Second Committee Member

Rachel E. Lookadoo, JD

Third Committee Member

Stephen Peters, MA

Fourth Committee Member

Dr. Benjamin Grin, MD, MPH

Abstract

The Save Adolescents from Experimentation (SAFE) Act is a law enacted in August of 2023 that bans gender-affirming medical care for individuals under eighteen years old in Missouri and states any medical provider who gives medical gender-affirming care to a minor will have their professional medical license revoked. The impact of medical professionals withholding proven gender-affirming care is a clear concern for the medical community, advocates, and other care professionals.

PURPOSE: The purpose of this policy review is to compare the content of the Missouri Save Adolescents from Experimentation (SAFE) Act with states with similar policies and standard-of-care practices set by prominent medical associations to provide an evaluative model. Additionally, this project attempted to assess the Act’s ability to provide equitable healthcare across the youth population of Missouri and consider the potential long-term physical and mental health impact of the law.

METHODS: This policy assessment utilized a modified assessment tool that was developed by the Centers for Disease Control and Prevention (CDC). The assessment included a synthesis of the actual policy through the legislation tracker, BillTrack50. A rapid literature review was utilized to compare the contents of the Missouri SAFE Act to other states with similar policies. Additionally, the rapid literature review will include a review of the current medical standard of care and guidelines for the medical treatment of transgender youth established by prominent medical associations to determine compliance. To conform to the CDC method of policy analysis, this capstone also applied a scoping literature review to explore if the act establishes equitable healthcare practices for minors within Missouri and the potential impacts- physical, mental, and social- that the Act may unintentionally cause for transgender youth receiving medical care within the state.

RESULTS: The Missouri SAFE Act is a regulatory policy that bans medical gender-affirming care of any type for minors. The Act contains subsections that ban Medicaid insurance coverage for gender-affirming care for all ages and gender-affirming care for any incarcerated individual in Missouri. A comparative analysis of the Missouri SAFE Act to other similar policies passed in other states showed that these subsections make the SAFE Act more restrictive than some policies while a lack of other components or penalties made it less restrictive than others. The perspective of prominent medical associations did not support the prohibition of gender-affirming care outlined by the Missouri SAFE Act because the Act impacted the provision of equitable care for Missouri minors.

RECOMMENDATIONS: State health policies, including the Missouri SAFE Act, should be amended, and reauthorized to reflect the current medical perspectives and standard-of-care guidelines outlined by medical experts within Missouri, throughout the United States, and internationally on gender-affirming care for transgender minors. Continued clinical research should be performed on long-term outcomes of anti-gender-affirming-care policies and gender-affirming medical treatments.

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Available for download on Tuesday, April 28, 2026

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