Why Should Delaware?
Youth experiencing gender dysphoria face higher risks of depression and suicide, but use of puberty blockers and hormone treatment has been shown to make a difference. Now, federal threats over that treatment are restricting families’ ability to access gender-affirming care in Delaware.
When 15-year-old Atlas McGinnis and his family moved to Delaware last year, they believed the state’s protections on transgender rights would finally allow him to access the gender-affirming care he needed.
A ban on such care in Missouri had left him feeling ostracized and dealing with discrimination at school and in public. In contrast, Delaware seemed like a safe haven.
But now, just months after arriving, McGinnis’s options have been limited once again.
In June, amid threats of Medicaid cuts from the Trump administration that have been looming over providers offering gender-affirming care services, Nemours Children’s Hospital officially stopped accepting new patients into its gender-affirming care clinic for medical treatment.
The clinic, which has provided services for transgender youth since 2018, will continue to treat existing patients and offer behavioral health services to new ones.
But its decision to halt new admissions leaves many Delaware families, and those who relocated for care, without vital access to the only known facility in the state that administers puberty blockers and hormone therapy for trans youth.
“The thought of not getting to do something you’ve waited for your whole life to do is frustrating,” McGinnis said.
Nemours has not yet made a formal public announcement about its decision, according to families and clinical social workers in the state. Instead, many heard the news directly from their providers, after contacting the pediatric hospital to seek care, or from other families.
McGinnis and his mother learned about the change in March after reaching out to Nemours to seek hormone replacement therapy (HRT). Now, he is looking for alternatives in Pennsylvania, but faces uncertainty about when or if he’ll be able to move forward with his transition.
But McGinnis is not alone.
Many families, providers, and advocates across the state now worry about the potential for further restrictions on gender-affirming care and the lasting effects it could have on the health, safety, and mental well-being of transgender youth.
“We’ve got families talking about leaving the country to go get access for their kids, and that’s wild. We live in a ‘sanctuary state,’ and we still have parents thinking about leaving,” said Leo Coddington, program facilitator at Emerald Lighthouse and a therapist with Rising Hope in Delaware.
Trump Medicaid threats prompt service cuts
In a statement to Spotlight Delaware, Nemours officials said the move to restrict access to gender-affirming care was in response to “evolving communications and actions from federal agencies directed at healthcare providers related to gender-affirming care.”
Since the beginning of this year, the Trump administration has rolled out a series of policies aimed at altering health care for transgender individuals. In January, Trump signed two executive orders that rejected the concept of gender identity, banned gender-affirming care for individuals under the age of 19, and threatened to withhold federal funding from institutions that continued to provide such care.
Following the order, federal agencies have been cracking down on hospitals to ensure they are not providing such care.
U.S. Attorney General Pam Bondi issued a memo in April stating that the DOJ would investigate any medical providers that “mislead the public about the long-term side effects of chemical and surgical mutilations.” The DOJ has sent more than 20 subpoenas to providers who have provided gender-affirming care.
Meanwhile, the Centers for Medicare & Medicaid Services (CMS) and the Health and Human Services Secretary Robert Kennedy Jr. escalated the pressure by giving hospitals 30 days to submit data and policies on gender-affirming care, and by instructing hospitals to disregard treatment protocols from the World Professional Association for Transgender Health (WPATH), citing risks like “psychiatric disorders” and “surgical complications.”
Nemours did not confirm what, if any, communications it received from federal officials.
But these policies have prompted hospitals across the nation and in surrounding areas to restrict access to gender-affirming care, including the University of Pittsburgh Medical Center, Penn State Health, Penn Medicine, Kaiser Permanente, and Children’s National Hospital.
Virtua Health, a prominent provider in Southern New Jersey, also confirmed in a statement to Spotlight Delaware that it will no longer offer puberty blockers and hormone therapy for those under 19.
The Children’s Hospital of Philadelphia did not respond to requests for comment on whether it still offers gender-affirming care.
ChristianaCare, which declined to comment on the matter, has removed all of its online content pertaining to its Gender Wellness program.
“My kid getting the care they need to be a happy, well-adjusted kid hurts literally no one. And yet our government is saying to our hospitals, ‘If you serve this community, then we’re not going to give you all of your federal funding for the cancer research or the sickle cell research you’re doing.’ I mean, it really is abusive,” said one Sussex County parent of a transgender child, who requested anonymity to protect their safety.
The heightened oversight from federal agencies, among other policies implemented by the new administration, has created significant uncertainty for health care providers like Nemours, which rely on federal funds.
In the fiscal year ending December 2023, Nemours Delaware Children’s Hospital generated approximately $700 million in revenue. Meanwhile, the Nemours Foundation, which operates facilities across Delaware, Florida, New Jersey, and Pennsylvania, reported over $2 billion in revenue. Of that, more than $780 million came from Medicaid and about $30 million more came from other federal funding sources, according to Nemours’ financial statements.
Delaware, a ‘sanctuary state’
Amid Nemours’ decision, Delaware has taken steps to protect its transgender residents.
Gov. Matt Meyer signed an executive order to protect gender-affirming care around the same time that Nemours made its decision.
But offficials from the governor’s office said that they were informed by hospital officials the night before the signing that no final decision on care had been made yet.
The executive order made Delaware a “sanctuary state” by providing legal protections for individuals and providers, so that they cannot be prosecuted in other states unless there’s a court order backed by a Delaware or federal court. The order also protects the data of individuals seeking gender-affirming care.
Those protections were then codified into Delaware law last week when Meyer signed House Bill 205.
Despite the efforts to make Delaware a welcoming space for transgender individuals, for some, the state protections are bittersweet.
“Looking at Delaware in the national context, I think we can appear to be a very safe and welcoming state for transgender Americans. But I think the reality on the ground is that far too many people are really struggling with being able to access that care because of all of these gaps in coverage right now,” said Mike Brickner, executive director of ACLU of Delaware.
Some families and advocates have begun to question why the state hasn’t taken more action. They suggested that the state could tell Nemours that they cannot restrict care – similar to actions taken in New York – or that the state could create a state fund to support gender-affirming services, similar to what it and other states have done with abortion care.
Brickner believes a state fund would be valuable and could help bring forward more providers to fill the high demand in gender-affirming care that is now outpacing the state’s current capacity.
However, officials from the governor’s office assert that they cannot stop the federal government from pulling funding from hospitals, which is used for gender-affirming care, among other research and patient treatments.
A spokesperson for Meyer’s office noted that, if the state provided new funds, the federal government could take dollars from the state in response. Without being careful, Delaware could lose up to a third of its budget, putting both the hospital and the state in a tough position, the spokesperson said.
With the lack of access to gender-affirming care in Delaware, families and providers alike are increasingly concerned about the long-term effects the gap in care could have on transgender youth.
Wait lists and multiple doctors
Puberty blockers and hormone therapy are common medical treatments used in gender-affirming care to help transgender youth align their physical characteristics with their gender identity and to alleviate gender dysphoria — the distress that can occur when a person’s gender identity differs from the sex assigned at birth.
These treatments generally require the child to see a therapist or social worker and receive parental consent before starting any medical treatments.
“I think the whole myth that you can just walk into a clinic and they’re giving you a prescription that day — there’s so much process you have to go through having a gender dysphoria diagnosis: being on wait lists, seeing multiple doctors, potentially freezing your eggs if you want to go into testosterone — like all of that goes into that,” McGinnis said.
But both families and providers stress that gender-affirming care begins with a child’s social transition, such as adopting a new name, changing pronouns, and changing their wardrobe, allowing them time to feel comfortable in their identity before any medical intervention is considered.
Although puberty blockers and hormone treatments have been shown to have potential side effects on bone density, fertility, and cardivolasuclar health, the treatments have also been proven to significantly lower depression, anxiety, and thoughts of suicide among transgender youth.
We’re literally just normal kids, like it’s not anything different. We just need extra medical care.
Atlas McGinnis
Leslie, a mother who moved from South Carolina to Delaware last year after her 16-year-old transgender daughter’s health care providers stopped her treatment, described how her daughter struggled with severe depression and was unable to care for herself before starting puberty blockers at Nemours.
“Seeing now who she’s becoming because she’s getting proper treatment is beautiful, and the possibility of that being snatched away again, and her whole freaking country pushing her out instead of the state. It’s just a lot,” said Leslie, who also asked to be identified only by her first name to protect her family.
Leslie’s daughter was fortunate enough to be able to continue care at Nemours, but they continue to worry about what the future may hold.
A 2020 study showed that 82% of transgender individuals have considered suicide, with suicidality highest among transgender youth. States that passed anti-transgender laws aimed at minors saw suicide attempts by transgender and gender non-conforming teenagers increase by as much as 72% in the following years.
“I don’t want us to lose a lot of kids, for families to start waking up and advocating for their neighbors,” said Karla Fleshman, clinical social worker and founder of Transitions Delaware.
Despite the grim reality, many remain committed to fighting for change.
Rep. DeShanna Neal (D-Elsmere), a longtime advocate for the queer community, has faced battles of their own, including fighting Medicaid over coverage for their transgender daughter’s puberty blockers. Neal’s daughter became the first patient to receive gender-affirming care at Nemours.
Though Nemours’ decision saddens Neal, they understand the difficult position the hospital faces. Neal remains optimistic that the state will continue to protect transgender individuals and asks that families find the strength to keep fighting.
“I didn’t fight this hard to see it completely wiped away, and so I’m not stopping at all until I know for a fact I can’t fight anymore,” Neal said. “I just need people to be as patient and as compassionate and as strong as possible, because I was doing this on my own for a long time, and I had to find a strength in me that I didn’t even know I had.”
As for McGinnis, while he and his family continue to search for care and secure treatment, he hopes that people understand the challenges transgender youth face in accessing gender-affirming care and the importance of recognizing their needs.
“We’re literally just normal kids, like it’s not anything different. We just need extra medical care,” he said.