Families weigh interstate moves to preserve transgender youth care

Families facing limits on transgender youth care are no longer arguing policy in the abstract. They are deciding whether to uproot their lives, cross state lines and start over so their children can keep seeing doctors, keep prescriptions, and keep treatment without fear that a ZIP code will decide the outcome.

Harleigh Walker, a 19-year-old transgender woman from Alabama, moved to Maryland after concluding she could not safely remain in her home state while pursuing the care she and her family believed she needed. Her move captures the hidden cost of the current patchwork: medical access is now entangled with housing, school plans and the decision of whether a family can absorb the disruption of leaving home.

The pressure has intensified since Donald Trump signed Executive Order 14187 on January 28, 2025, directing the federal government to work to limit gender-affirming care for people under 19. A federal judge in Maryland, Brendan Hurson, issued a temporary restraining order on February 13, 2025 blocking enforcement nationwide, but litigation and follow-on agency actions have kept the issue alive. The Justice Department has also subpoenaed health-care providers for records tied to gender-affirming care, another move that courts temporarily blocked.

At the state level, the map is already fragmented. KFF says 27 states have laws or policies restricting minor access to gender-affirming care, and its broader policy tracking shows more than half of states limit youth access in some form. For families, that has turned medical planning into geographic planning, with some weighing a move simply to preserve a stable doctor-patient relationship.

The scale of the population affected is large. The Trevor Project’s 2025 national survey reached more than 16,000 LGBTQ young people ages 13 to 24, and nearly one-third said they or their families were considering moving to another state for care. The Williams Institute at UCLA later estimated that more than 2.8 million people age 13 and older identify as transgender in the United States, including about 724,000 transgender youth ages 13 to 17.

The policy fight has also reached hospital finances. On May 28, 2025, the Centers for Medicare & Medicaid Services sent letters to select hospitals asking for information about pediatric gender-affirming care practices and finances, then proposed rules that would bar hospitals from Medicare and Medicaid participation for providing such care. That matters because Medicare and Medicaid payments are core revenue streams for hospitals, and pressure from Washington has already changed behavior: in February 2026, more than 40 hospitals nationwide had paused or stopped some gender-affirming care for young people.

Major medical groups, including the American Academy of Pediatrics, the American Medical Association and the Endocrine Society, continue to support access to evidence-based care. For families like the Walkers, the result is a national system where health care can hinge less on medicine than on geography, and where staying in place can mean losing treatment altogether.