Michigan’s transgender community and supporters are reeling in the wake of President Donald Trump’s executive order recognizing only “male” and “female” sexes, even as the implications for healthcare coverage in the state remain uncertain.
“One of the most jarring” concerns that’s been voiced to Roz Gould Keith, the executive director and founder of Stand with Trans, “is that parents believe that their child will be motivated to take their life, because they will feel hopeless,” she said Tuesday.
They’re worried their “rights are being taken away, that they can no longer access gender-affirming care,” she said. “They can't get the meds that they rely on for their medical transition, while their identity is being invalidated if they identify as non-binary.”
The state health department says it’s “reviewing” whether Michigan’s Medicaid coverage for gender-affirming care clashes with the order, which says federal funds “shall not be used to promote gender ideology.”
But the Michigan Secretary of State’s office says it will continue to offer a nonbinary “X” designation on driver’s licenses and state ID. The executive order this week instructed federal agencies to “require that government-issued identification documents, including passports, visas, and Global Entry cards, accurately reflect the holder’s sex.”
“We understand that people are anxious and confused about what the executive order means for themselves, their loved ones, and their community,” a Michigan Secretary of State spokesperson said via email Tuesday. “The executive order does not affect our state policy and procedures. We will not stop providing an inclusive nonbinary option for Michiganders on state driver’s licenses and IDs.”
Uncertainty about Medicaid coverage for gender-affirming care
Michigan’s Medicaid plan “covers medically necessary gender affirmation/confirming medical, surgical, and pharmacologic treatments and procedures for beneficiaries clinically diagnosed with gender dysphoria,” according to 2021 guidelines.
“We have a great Medicaid plan in the state of Michigan in terms of transgender people being able to access medically-necessary gender affirming care,” said Jay Kaplan, staff attorney for the ACLU of Michigan’s LGBTQ+ Rights Project.
“Will the federal government try to take away federal dollars from our state Medicaid program if we continue to offer gender affirming care? And if they try to do that, is there a way that the state can segregate those Medicaid state dollars, so they can continue providing this health care [with state dollars alone?]” Kaplan wondered.
Trump’s order says federal agencies “shall take all necessary steps, as permitted by law, to end the Federal funding of gender ideology,” and instructs the U.S. Department of Health and Human Services to provide “clear guidance expanding on the sex-based definitions set forth in this order” within 30 days.
And it instructed the U.S. Attorney General to “ensure that no Federal funds are expended for any medical procedure, treatment, or drug for the purpose of conforming an inmate’s appearance to that of the opposite sex.”
Michigan civil rights protections for gender identity
Trump’s order rescinds the Biden administration’s previous executive orders and guidance, which provided broad protections against discrimination on the basis of gender identity in schools, housing and employment.
But the state’s Elliott-Larsen Civil Rights Act was expanded in 2023 to include gender identity and expression.
"So we have these laws in place that say to folks in Michigan, ‘If you discriminate against LGBTQ people by even engaging in some of these policies here with regarding bathrooms, or whether or not you're protected against discrimination in school, things like that, you are subject to those those state civil rights laws,'” Kaplan said.
“And we will use every tool in our arsenal we have, should anyone in the state of Michigan take a page from the Trump administration and believe that this has given them a license to discriminate against LGBTQ people and and especially transgender people in the state of Michigan.”
Even if Michigan’s legal protections and Medicaid coverage remain unchanged for transgender residents, Gould Keith is worried about the message the executive order (and Trump campaign ads about transgender identity) are sending.
“The hate, the vitriol that that people feel, and that is being fed and fueled by new policies, new statements, new potential policies is just so harmful and detrimental,” she said. “Honestly, the trans community represents about 2% of the population. Two percent. And the populations are much greater for those who are struggling economically, or those who need stable housing. There are so many big issues and big concerns that a lot of people have in our country. And that should be, in my opinion, the first [issues] that are discussed.”
