Editor’s note: This story was originally published at 4:45 p.m. on Oct. 1, 2024. It was updated at 1:52 p.m. on Oct. 2, 2024 to correct that Clarence Lam is a state senator. A previous version cited Lam as a state delegate.
Gender-affirming care was added to Maryland’s definition of legally protected health care on Tuesday as Maryland’s Trans Shield Act, which was sponsored by Silver Spring representative and House Majority Leader Del. David Moon (D-Dist. 20), went into effect.
Advocates say this legal change will make Maryland a “sanctuary state” for transgender people seeking medical care.
The law ensures that states that ban gender-affirming care can’t wield private health records against transgender Marylanders and their physicians. It will protect Maryland residents and patients who live outside of the state who receive gender-affirming care within the state, as well as their physicians, from legal action and prosecution for receiving or providing that care.
The Senate version of the bill was sponsored by Sen. Clarence Lam (D-Dist. 12), who represents Anne Arundel and Howard counties. The legislation was co-sponsored by a majority of the Montgomery County delegation and passed through the General Assembly in April. Gov. Wes Moore (D) signed off on the bill on May 16. This makes Maryland the 12th state in the country to have a shielding law that includes gender-affirming care, according to the Trans Rights Advocacy Coalition of Maryland.
The aim of the law is to stop out-of-state criminal and civil judgments, subpoenas, investigations, extraditions and warrants. No other state will be able to suspend a physician’s professional license in Maryland for providing gender-affirming care.
“We are not going to be in the business of having our states facilitate and cooperate with out-of-state prosecutions and investigations and access to our medical records,” Moon said at a hearing before the House Health and Government Operations Committee in February.
The Trans Shield Act mirrors abortion shield laws passed last year in Maryland. Moon has said the legislation reflects existing anti-discrimination laws. It doesn’t make any changes to the laws regarding who can legally receive gender-affirming care and does not change the scope of care. It only addresses legal privacy. It also does not prohibit patients from filing malpractice claims and suits against medical providers.
In a March 2023 report, the U.S. Department of Health and Human Services defined gender-affirming care as “a highly specialized model of care that uses evidence-based practices to address distress arising from gender dysphoria.”
This care can vary based on the individual, but may include hormone replacement therapy, surgery and alterations to various parts of the body, voice therapy, and other health care intended to help align a person’s body with their gender identity.
Moon has said that gender-affirming care can include therapy and mental health services to aid in suicide prevention for LGBTQ+ individuals.
“Gender-affirming care is life saving and medically necessary and that our health care workers and support networks should not be penalized for providing care that’s in line with the current clinical standards of care, no matter what other states have to say about it,” Brige Dumais, an advocate with the Trans Rights Advocacy Coalition of Maryland, told MoCo360 during the General Assembly session.
Major medical organizations including the American Medical Association, American Academy of Pediatrics, and the American Psychiatric Association designate gender-affirming care as medically necessary. The federal government has named gender-affirming care as an “essential health benefit” protected under Section 1557 of the Affordable Care Act, and last year, Maryland lawmakers passed the Trans Health Equity Act sponsored by Montgomery County-based Del. Anne Kaiser (D-Dist. 14), which requires Maryland Medicaid to cover gender-affirming care for transgender residents.
The Trans Shield Act was endorsed by medical organizations including the Maryland Board of Physicians. However, it faced opposition during the legislative process from critics who are opposed to gender-affirming care access and who said the legislation would encourage people to seek the care and make it easier to access.
A failed amendment proposed by Del. Nino Mangione (R-Dist. 42A), who represents Baltimore County, would have banned gender-affirming care involving surgery for minors. Another amendment, proposed by Del. April Miller (R-Dist. 4), who represents Frederick County, also failed; it would have required each parent and/or legal guardian of a child receiving gender-affirming care to submit a notarized consent form.
The expansion of gender-affirming care became a hot topic in Montgomery County after Moore declared Maryland a sanctuary state for transgender health care access in June, making it the 11th state to do so alongside the District of Columbia.
The Trans Shield Act is part of the larger effort by LGBTQ+ advocates and local legislators to support policies that will make Maryland a true sanctuary state for transgender people and their families. This effort can be seen on the county level as well.
A Jan. 16 report by the Montgomery County Office of Legislative Oversight commissioned by Council Vice President Kate Stewart (D-Dist. 4) found the county government could be doing more to support its transgender residents. It recommended officials consider creating a resource center and lobbying the state to require cultural competency training for medical providers throughout the state.
