Tennessee this week joined two dozen other states in banning gender-affirming medical care for young people who are transgender.

The U.S. Supreme Court upheld Tennessee's ban in a 6-3 decision. Detractors see it as a form of discrimination.

Chase Strangio, co-direcor of the ACLU's LGBTQ and HIV Project, said the high court's opinion will leave families across the country scrambling to maintain health care. Strangio said some young people who are losing access to treatment are doing everything they can to continue care approved by doctors and parents.

"The most immediate effect is on our clients and other young transgender people, in Tennessee and across the country, who need medical care that the government has stepped in to ban," he said. "And for them, we are devastated, and we know that we will continue fighting so that government discrimination against transgender people will end."

Chief Justice John Roberts said the court found Tennessee's ban on gender-affirming care for minors doesn't violate the 14th Amendment's Equal Protection Clause. The lawsuit, U.S. v. Skrmetti, was filed by families in Nashville and a Memphis doctor, who argued the law is unconstitutional. The Biden administration initially supported the case, but the federal government has changed course during the Trump administration.

Karen Loewy, director of constitutional law practice for the advocacy group Lambda Legal, called the ruling "heartbreaking" for families and the medical providers who want to see transgender youths live safely and be their full, authentic selves. She said the decision denies them basic dignity and protection.

"It's very important to note the specifics of the court's ruling," she said, "which is really limited to laws that bar medical treatments for minors where there's no evidence that the law was based on animus, where there's no argument that the bans are just a proxy for discrimination against transgender people."

Loewy added that Justice Sonia Sotomayor's dissent acknowledges the serious harm transgender youths face without access to gender-affirming care.

Lucas Cameron-Vaughn, senior staff attorney at ACLU of Tennessee, said families he's spoken with are disappointed in the ruling. He noted that a young person now has no access to gender-affirming medical care in the state, and not all are able to get it elsewhere.

"Our clients and a lot of trans youths in Tennessee have supportive families and have the privilege and ability to be able to take time off work and school, to be able to go out of state to obtain medical care," he said. "But so many other young people do not have families that support them to try to assist them in getting that care from out of state."

The court did not overturn existing Supreme Court or lower court rulings that recognize other forms of discrimination against transgender people as unlawful.


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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.