TOLEDO – House Bill 68, in effect since April 24, 2024, has dramatically changed how both patients, healthcare workers and schools approach medical care and sports participation for trans-identifying youth.
According to Bill Track 50, the Enact Ohio Saving Adolescents from Experimentation (SAFE) Act, sponsored by Gary Click (R-Vickery), prohibits physicians from performing gender reassignment surgery or prescribing cross-sex hormones or puberty-blocking drugs for the purpose of assisting minors with gender transition, with limited exceptions; requires mental health professionals to obtain parental consent before diagnosing or treating a minor for a gender-related condition, and to screen for other potential underlying issues; prohibits Medicaid coverage for gender transition services for minors, with exceptions.
The bill also enacts the Save Women’s Sports Act, which requires schools, state institutions of higher education, and private colleges to designate separate single-sex teams and sports for each biological sex, and prohibits individuals of the male sex from participating on female sports teams.
Since the bill has been in effect, practices and programs that seek to treat patients have sought legal counsel and direction from organizations like the National Association of Social Workers (NASW), which has helped organizations define how their programs can move forward after new regulations from HB 68.
Kurt Landis, executive director and therapist at Center for Greater Healing, said his practice has participated in training sessions with NASW. “They’ve been extremely helpful in navigating changes from this bill. They’ve come into our office to train staff on changes and how to best move forward.”
According to Mary M. Wesley, of Rainbow of Hope Counseling, the help provided by NASW has allowed her to keep the doors of her practice open.
“I’ve had to work with the NASW and other lawyers [concerning liability] to have the wording in my consent form that allows me to do my job.”
Welsey’s practice touts itself as a safe place for LGBTQ+ patients. Because minors need to receive permission from their parent or guardian(s) to attend therapy, most of the patients she sees have already come out to their parents. Despite this demographic, she said she has had to go to great lengths to educate herself on how to run her program safely.
Patient safety is paramount to these practices, making the bill a grave concern in its requirement that healthcare programs out their patients.
“It quite literally goes against our code of ethics,” says Wesley. “It’s not my job to out patients. They’re scared to come to therapy because they may say something that outs them to their parents, who may or may not be abusive. It’s a safety risk for someone to be out.”
Because Ohio and Indiana have prevented the request of hormones from minors’ physicians, patients receiving testosterone or estrogen supplements sometimes need to travel to other states in order to receive their medication.
“Depending where you live, you will need to go out of state to receive hormones,” said Wesley as she describes how her patients lives have been changed since the bill’s enactment.
“There are other ways people can get hormones that aren’t so safe. People will go to extremes if they need to because it’s that important to them. It’s important to be themselves and not be forced to live in a way they’re not comfortable [with], and, in some cases, it can make them not want to live.“
Having to travel upwards of 45 minutes to seek medical care that may or may not be covered by their insurance incurs more costs and accessibility barriers. To address this, some organizations have started funds for individuals to get to appointments and medication, though this is a temporary solution.
The NW Ohio LGBTQ+ Coalition is working on implementing a program to address patient concerns surrounding safety and health when seeking a provider. The program addresses changes and concerns in the wake of the bill, creating a certification that identifies a medical practice or program as having gender identifying care.
Landis volunteers for the Coalition and describes what the rating system entails. “We look at things like what kinds of bathrooms are available, the layout of the space, and we also talk with staff of the facility regarding steps they take in their practice.”
Wesley is also a volunteer for the Coalition and looks forward to the positive impact the gender affirming certification will make. “I get so many clients that have been just treated like crap, whether that be mental health professionals or medical doctors. This program will be such a huge help to people looking for safe healthcare.”
There’s no current standard of certification that healthcare programs could accredit themselves with as LGBTQ+ affirming practices. The one certificate option available is exorbitantly expensive. The Coalition’s approach to identifying healthcare programs that are LGBTQ+ affirming is low-cost and relatively easy to implement.
Despite the fear and constant change the trans community is facing, programs and mental health practices, like those mentioned here, are working to help mitigate negative impacts.
“With the changes going on, patients are expressing concern with maybe this space not being here or our practice shutting down,” says Landis. “I reassure them, we’re not anywhere near that right now; we’re dedicated to be here and keep doing what we’re doing.”
