South Dakota is once again locked in a debate over a bill concerning transgender youth.

It seeks to ban gender-affirming care, with supporters saying they want to protect minors, while opponents call it a major intrusion on a family's personal medical decisions.

The state Senate is expected to take up the bill after it was overwhelmingly approved by the House last week. It would prohibit treatments like hormone therapy for those under 18.

Bill sponsors say adolescents shouldn't be seeking out care they might regret. But Susan Williams, executive director of South Dakota's Transformation Project Advocacy Network, pointed out that these aren't rash decisions made by teens on their own.

"Gender-affirming care would start with a therapist meeting with a family, meeting with a youth and doing several assessments," said Williams. "That can take six months or more."

She said lawmakers trying to have their say would be violating a family's privacy.

The U.S. Department of Health and Human Services says having this care for adolescents is a crucial part of helping them thrive.

Last year, South Dakota approved a law banning transgender youth from participating in school sports consistent with their gender identity. Other conservative states have adopted similar laws, including targeting gender-affirming care.

Williams said she feels there's too much misinformation being floated within these debates.

"They're using words like 'genital mutilation' and 'chemical castration,'" said Williams, "and these words are meant to instill fear in the general public."

The HHS says procedures such as gender-affirming surgeries are typically used in adulthood.

Meanwhile, some of the laws in other states have led to lawsuits. Opponents of the South Dakota bill predict as currently written, it would lead to costly litigation.

Rural LGBTQ+ youth in Indiana face greater mental health challenges, but have found ways to build community online, according to a new report. 48% of the state's LGBTQ-plus youth live in a small city or town, according to the 2024 Survey on the Mental Health of LGBTQ+ Young People in Indiana study. The next largest region is the suburbs.

Michael Parent, principal researcher with HopeLab, said the demographic has difficulty finding support in their communities, compared to their urban peers, but noted that there are some positive trends too.

"They had a lot of sense of internal pride in their identity," he said. "So despite being in some more challenging circumstances, they also had really positive internal feelings about themselves."

Parent added that, while young LGBTQ+ people in rural areas struggle to connect in person, they often find friends online. Those communities can be based around a shared LGBTQ+ identity but can also involve a shared passion for gaming or art. 53% of this demographic in Indiana are aged 18-to-24, while 47% are between 13 and 17.

Data from the survey found that family and community are seen as places of affirmation - an environment of validation through a sense of belonging, safety, and respect. Parent agrees community plays an important role, but pointed to a lack of in-person support for rural LGBTQ+ youth.

"Rural LGBTQ+ young people are having a lot of challenges in their circumstances and environments," he added. "But finding that they had a lot of internal sense of pride in their identity is really positive and was surprising, because we didn't really think that would show up."

Other ways to show support for the community include not supporting politicians that advocate for anti-LGBTQ+ legislation, accepting their partner, and doing research about gender identities.


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Advocacy groups are speaking out about how they believe congressional cuts to Medicaid will disproportionately affect caregiver LGBTQ+ communities in Illinois.

Jaimie Worker, senior director of policy and research for the advocacy group Caring Across Generations, said Medicaid can be a lifeline for LGBTQ+ people who are aging or living with disabilities, especially those without traditional family support. She explained for many, care is provided by "chosen family" or friends, with support from Medicaid largely making that possible.

"LGBTQ+ communities are impacted in a unique way when it comes to self-directed care: being able to choose who your care provider is as an older adult or person with a disability," Worker pointed out. "Many of these programs are heavily supported by Medicaid."

She noted as people already face barriers to receiving the care they need, Medicaid cuts would unnecessarily force some into institutional settings like nursing homes, where they would never have chosen to receive care.

An estimated 700,000 people nationwide are on waiting lists to receive home- and community-based care through Medicaid. Last year, more than 15,000 were in Illinois. No matter how dire their need, Worker stressed people can wait years to access these services and LGBTQ+ individuals face additional barriers.

"Those are the folks who already know about the services; not everyone is aware about the services that are available. LGBTQ folks are also more likely to experience discrimination while trying to access care needs."

Currently, people who make less than $22,000 a year in Illinois could qualify for Medicaid. Worker predicts new federal qualifications will make it more difficult for people to qualify, even with extremely limited resources.

"And make it harder for people to live and age with dignity, and largely in their own homes and communities where most people would prefer to live and age," Worker underscored.

She reported starting July 24, Caring Across Generations will host a 60-hour vigil for Medicaid in Washington, D.C., to amplify the stories of caregivers, people with disabilities, older adults and families from across the country.

This week, the law guaranteeing same-sex marriage equality turned 10. But advocates are concerned about the growing number of threats it now faces.

A decade after the Supreme Court's historic Obergefell v. Hodges decision, most Americans are onboard with gay marriage. While President Donald Trump has never stated outright opposition, members of his conservative base do. And with a conservative Supreme Court majority, Justices Samuel Alito and Clarence Thomas have also signaled they'd like to revisit the issue.

Despite pressure from the far right, said Jenny Pizer, chief legal officer at Lambda Legal, ending same-sex marriage isn't something that has public support.

"I think what is key for people to have in mind is, there's no case in front of the Supreme Court pending for a court review at this moment," she said, "and the Supreme Court can't review a case and consider a case without there being a case -- and there is none at this point."

She reminded folks that Congress passed the Respect for Marriage Act in 2022, which codified marriage protections for same-sex and interracial couples. It also repealed the Defense of Marriage Act, a 1996 law that exclusively recognized marriage between one man and one woman.

In 2020, Nevada became the first state to enshrine gay couples' right to marry in its state Constitution.

Even if the law were overturned and certain states were what she called "hostile" to same-sex couples who want to marry, Pizer said, states would have to continue to respect and honor same-sex marriages. She added that folks should not be panicking, but should be paying attention.

"The bottom line is that we have to keep our eye on this," she said. "We know that there are those on the far right who want to raise money on this issue, want to gin up fears on this issue, use it for organizing."

Since the Supreme Court's decision in June 2015, almost 600,000 same-sex couples have married legally. In the United States alone, there are about 823,000 married gay couples, according to the Williams Institute at the UCLA School of Law.