COLUMBIA, Mo. (AP) — Two new laws restricting the access of transgender youth in Missouri to gender-affirming health care and school sports took effect Monday.

One law bans minors from beginning puberty blockers and hormones and outlaws gender-affirming surgeries for youths. The other law requires student athletes from kindergarten through college to play on sports teams that align with their sex as assigned at birth.

Republican Gov. Mike Parson signed the bills in June after he and other proponents of the laws pressured the GOP-led legislature to act during this year’s session. Both laws are set to expire in 2027.

LGBTQ+ advocates who sued to overturn the health care law were dealt a blow last week when a judge allowed the law to take effect as the court challenge plays out.

HEALTH CARE

The health care law prohibits physicians from providing gender-affirming health care to minors, but young people prescribed puberty blockers or hormones before Aug. 28 can continue to receive those treatments.

Missouri’s Planned Parenthood clinics had been ramping up available appointments and holding pop-up clinics to start patients on treatments before the law took effect.

Adults still have access to transgender health care under the law, but Medicaid will not cover it and prisoners’ access to surgeries is limited.

Missouri Department of Social Services spokeswoman Caitlin Whaley said Monday that the state’s Medicaid program “has not historically paid” for gender-affirming surgeries. She said the agency has already enacted changes to Medicaid to prevent payments for hormones and puberty blockers.

Dr. Colleen McNicholas, chief medical officer of Planned Parenthood of the St. Louis Region and Southwest Missouri, said the ban on Medicaid coverage might mean adult patients already receiving treatments will need to switch to providers who accept out-of-pocket payments.

Republican Attorney General Andrew Bailey on Monday sent a letter to a handful of health care providers, including Planned Parenthood, warning that the law is now in effect. Bailey had tried to enact limits on gender-affirming health care through rulemaking earlier this year. His office is now defending the health care law in court.

Physicians who violate the law face having their licenses revoked and being sued by patients.

A gubernatorial-appointed state board of physicians is responsible for doctors’ licensure and revocation in Missouri.

LAWSUIT

The ACLU of Missouri, Lambda Legal, and Bryan Cave Leighton Paisner filed suit last month seeking to overturn Missouri’s transgender health care law on behalf of doctors, LGBTQ+ organizations, and three families of transgender minors. Arguing that the law is discriminatory, they asked that it be temporarily blocked as the court challenge against it plays out. A St. Louis judge disagreed, and last week ruled that the law can take effect throughout the lawsuit.

The next hearing in the case is scheduled for Sept. 22.

SCHOOL SPORTS

Beginning Monday, student athletes will only be allowed to play on K-12 and college sports teams that align with their sex assigned at birth. That means transgender girls and women will not be allowed on girls’ and women’s school teams, and transgender boys and men can only compete on girls’ and women’s teams.

Girls and women can play on boys’ and men’s teams if there is no corresponding sports program for girls and women.

Compliance is based on students’ birth certificates or other government documents, but only records created shortly after birth are acceptable. Modified birth certificates are only allowed in cases of typos and other mistakes.

The state education department is responsible for creating additional rules for enforcement of the law, which isn’t facing a challenge.

Schools, including private institutions, face losing all state funding for violating the law. Parents, adult students and former students can sue if they believe a violation of the law led to the loss of an “athletic opportunity” for them.

OTHER STATES

At least 22 states have enacted laws banning or restricting gender-affirming care for minors, and most of the bans are being challenged in court.

The most recent state to enact a ban was North Carolina, where Republican lawmakers overrode Democratic Gov. Roy Cooper’s veto of a measure banning medical professionals from providing hormone therapy, puberty-blocking drugs and surgical gender-transition procedures to anyone under 18, with limited exceptions.

North Carolina’s law took effect immediately. But minors who began treatment before Aug. 1 may continue receiving that care if their doctors deem it medically necessary and their parents consent. Opponents of the law have vowed to file a lawsuit challenging it.

A federal judge in June struck down Arkansas ′ first-in-the-nation ban, and the state has appealed that decision. The judge in that case ruled the prohibition violated the constitutional rights of transgender youth and families, as well as those of medical providers. He also rejected proponents’ claims that the treatments were experimental.

People opposed to such treatments for children argue that they are too young to make such decisions about their futures.

Every major medical organization, including the American Medical Association, has opposed the bans on gender-affirming care for minors and supported the medical care for youth when administered appropriately.

The American Academy of Pediatrics earlier this month reaffirmed its support for the treatments, and voted to conduct an external review of research regarding the care.