Transgender adolescents in Minnesota can now rely on their state’s Medicaid program to cover transition-related medications like hormones and puberty blockers, as The Star Tribune reported over the past weekend.

This is great news, obviously. Leading medical experts and organizations in the United States, including the American Association of Pediatrics and the World Professional Association for Transgender Health, agree that giving trans teens access to gender-affirming treatment is the best way to alleviate gender dysphoria. And trans kids themselves often have an understanding of their gender by a very young age, as a recent study reported on by Reuters last week found.

Trans teens are disproportionately likely to attempt suicide compared to their cis peers, a risk which is associated with rejection of their gender identity by family, friends, and even medical providers. “Treatment delay has put adolescents at risk,” Dr. Kelsey Leonardsmith of Family Tree Clinic in St. Paul told The Star Tribune. “I’ve been pleased with our ability to get these vital, life-saving medications.”

Unfortunately, great news like Minnesota's is hard to come by in the United States. For many trans young people, gender-affirming treatment can be very difficult to obtain, despite fear-mongering to the contrary that purports such care to be too accessible to minors: Medicaid programs only cover transition-related medical treatment explicitly in 21 states, according to the Movement Advancement Project, and 10 states explicitly exclude patients from using Medicaid programs to cover transition-related care. Even if trans youth don’t live in a state in which public healthcare coverage denies gender-related treatments, they may still have to contend with gatekeeping practices from transphobic medical providers, like denying hormone prescriptions or doubting a patient’s stated gender identity, or disapproving parents, whose permission is generally required in order for a minor to obtain a prescription for hormones or puberty blockers—even in Minnesota after the state’s latest change to Medicaid.

Even fewer states explicitly cover minors’ trans health needs, though that, too, is changing in some parts of the country. In October, Vermont approved a proposal to remove age restrictions on people seeking Medicaid coverage for gender-affirming surgeries, allowing trans youth under the age of 21 to pursue such procedures. Perhaps more will follow suit. Gender-affirming medications are life-saving, but they can’t save lives if they’re kept out of the hands of the trans teens who need them.

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