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What to know about gender-affirming care in Mississippi 

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What to know about gender-affirming care in Mississippi 

Mississippi lawmakers are considering a bill that would ban gender-affirming care for trans kids this session, sparking fear among LGBTQ+ Mississippians and their families and allies.

House Bill 11125, also known as the “Regulate Experimental Adolescent Procedures” (REAP) Act, would prevent Mississippi’s roughly 2,400 trans kids and their families from getting hormone therapy or puberty blockers in the state. Lawmakers, contradicting the recommendations of every major medical association in the U.S., have likened gender-affirming care to child abuse and say the bill will protect children.

Trans Mississippians and their allies have said the bill is part of a coordinated attack on their rights. The bill comes two years after lawmakers banned trans athletes from competing on sports teams that align with their gender identity.

As the bill moves through the legislative process, Mississippi Today compiled answers to some commonly asked questions about HB 1125 and gender-affirming care.

What is gender-affirming care?

Gender-affirming care refers to a broad range of interventions, from medical treatment to psychological and social support, that aims to affirm an individual’s gender identity, especially when it is different from the one they were assigned at birth, according to the World Health Organization. It seeks to reduce gender dysphoria, the distress trans people can experience when their physical features do not match their gender identity. The Transgender Care Navigation Program at the University of California, San Francisco, says gender-affirming care can range from “coming out” to friends and family, using different pronouns and changing one’s hairstyle, clothing to going on puberty blockers, hormone therapy or surgery.

Puberty blockers are a type of medication that prevents sex organs from producing estrogen or testosterone. They are reversible and have been used for decades for precocious puberty, the development of secondary sex characteristics at a young age, in cisgender kids. Hormone therapy – the prescription of estrogen or testosterone – typically starts at 16-years-old for trans kids.

For trans kids, who must have parental consent, the goal of gender-affirming care is often to give them time to determine if they want to go through puberty corresponding to the sex they were assigned at birth or if they want to transition, said Lee Pace, a nurse practitioner and co-owner of Spectrum: The Other Clinic, the only transgender medical clinic in Mississippi.

Gender-affirming care is recommended by every major medical association in the United States. It is also evidenced-based and, contrary to the title of HB 1125, not considered “experimental” by the medical community.

In a blog post on the American Medical Association’s website, the president, Jack Resneck, wrote that, “studies have consistently demonstrated that providing gender-affirming care that is both age-appropriate and evidence-based leads to improved mental health outcomes. Conversely, denying such care is linked to a greater incidence of anxiety, depression and self-harm.”

Nationally, trans youth attempt suicide at a rate more than four times their cisgender peers due to social stigma and discrimination. Research has repeatedly shown that gender-affirming care significantly boosts the chances that trans kids will live to see adulthood. A study published last year in the peer-reviewed Journal of the American Medical Association found that over the course of a year, gender-affirming care was associated with 60% reduced odds of moderate to severe depression and 73% less odds of suicidal thoughts.

Are trans youth undergoing gender-confirmation surgery in Mississippi?

No. On the House floor, Rep. Nick Bain, R-Corinth, could not name a single instance of a trans kid undergoing gender-confirmation surgery in Mississippi.

There is no medical clinic in Mississippi that offers gender-confirmation surgery to trans kids, according to Pace and other advocates for the state’s trans community. In general, surgery is not recommended for trans kids by medical organizations that support other forms of gender-affirming care for youth.

No clinic in Mississippi provides what’s commonly called “bottom surgery” to trans people of any age, though adults can access chest surgery in the state.

A handful of trans kids in Mississippi are receiving gender-affirming care. At Spectrum, Pace estimated that in the last two years, he has seen 30 trans kids for care and less than half have had parental consent to go on puberty blockers. The number of trans kids across the country who are on puberty blockers is similarly small. According to an investigation in Reuters based on insurance claims, just 1,390 trans kids ages 6-17 in the United States were prescribed puberty blockers in 2021.

How would HB 1125 be enforced?

HB 1125 is enforced by a civil, not criminal, process in which anyone who “aids or abets” gender-affirming care for a trans child could be sued for monetary damages for up to 30 years. In addition, doctors who continue to provide gender-affirming care after the bill passes could lose their license.

The State Board of Medical Licensure, which would enforce the bill’s provision revoking providers’ licenses, didn’t respond to questions from Mississippi Today. The University of Mississippi Medical Center, which has provided gender-affirming care to trans kids at its LGBTQ-focused TEAM Clinic, said, “we have no comment for now.”

McKenna Raney-Gray, staff attorney for the American Civil Liberties Union of Mississippi’s LGBTQ Justice Project, said on a call last month that the bill is designed to make it so doctors in Mississippi have no incentive to provide gender-affirming care.

How would this legislation affect access to gender-affirming care in Mississippi?

The bill will go into effect immediately. Spectrum is likely the one provider in the state offering gender-affirming care to trans kids, Pace said, and he will stop treating the handful of 16 and 17-year-old trans teenagers in his care the moment the bill passes. His wife and co-owner of the clinic, Stacie Pace, said they will likely post signs on the clinic’s front door saying they no longer accept trans children.

It is unclear if the bill will prevent doctors in Mississippi from referring families and trans kids to out-of-state providers.

Still, the small number of families seeking gender-affirming medical care involving puberty blockers or hormone treatment will have to go out of state if the bill passes, though some people worry this also would not be allowed under the bill’s “aids and abets” clause.

During a Senate Judiciary B committee hearing last month, Sen. Joey Fillingane, R-Sumrall, said he did not think the bill would prevent families from going out of state for care.

“We only control the law within the boundaries of the state of Mississippi,” he said. “Now if parents use it to go to New York or wherever they want to go – L.A. – and do this, that would be controlled by the laws in that state.”

Who supports HB 1125, and why?

The bill is authored by Rep. Gene Newman, R-Pearl. He has not responded to a request for comment from Mississippi Today. It is backed by a coalition of powerful Republican lawmakers in Mississippi, including Gov. Tate Reeves and House Speaker Philip Gunn, and endorsed by conservative and religious organizations like the Alliance Defending Freedom.

These lawmakers and groups have cast the measure as a way to protect children in Mississippi, sometimes likening gender-affirming care to child abuse. At a rally last month, Gunn said he did not think children in Mississippi should be allowed the choice to transition with puberty blockers or hormones.

“We have decided as a society that children are not always capable of making decisions based on age, lack of maturity and lack of understanding,” he said. “Is there any more consequential decision than changing one’s sex?”

Reeves echoed Gunn during his State of the State address.

“The fact is that we set age restrictions on driving a car and on getting a tattoo,” Reeves said. “We don’t let 11- year- olds enter an R-rated movie alone, yet some would have us believe that we should push permanent, body-altering surgeries on them at such a young age.”

What do trans Mississippians, their supportive families and providers of gender-affirming care think of the bill?

Trans Mississippians call the bill an attack on their rights. Jensen Luke Matar, director of the nonprofit Trans Program, said on a call last month that lawmakers are using trans Mississippians as political bait.

“It’s just chess,” said Matar, a trans man. “They’re playing chess, and they’re using the most vulnerable population as their pawns.”

Supportive parents are devastated by the measure and afraid of what will happen if their trans kids can no longer receive gender-affirming care, Pace said. Many parents are still trying to figure out how to tell their kids that Mississippi is considering this bill, according to parents who spoke with Mississippi Today on the condition of anonymity. Some are considering the possibility of moving away to states like California and Colorado that have laws protecting gender-affirming care.

Providers of gender-affirming care in Mississippi say the bill will contribute to increased mental illness among LGBTQ+ Mississippians and are worried it will lead to higher suicide rates if it passes.

“The number one thing, if this bill goes into effect? A lot of dead kids,” Stacie Pace told Mississippi Today. “This law goes into effect, it is, in my opinion, the direct cause of youth suicide.”

What forms of gender-affirming care for trans minors would still be permitted under HB 1125?

Raney-Gray of the ACLU said the bill will not ban social transitioning, such as using new pronouns or wearing different clothes, for trans youth in Mississippi.

It remains unclear how the bill could affect access to gender-affirming care that is provided through a counselor or if that would fall under the measure’s “aids and abets” clause. Counselors across the state who have worked with trans people told Mississippi Today that if they accept a trans child as a client, they would seek legal guidance.

READ MORE: ‘Kids will kill themselves’: Providers of gender affirming care say anti-trans bill will be a direct cause of suicide

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

Mississippi Today

IHL deletes the word ‘diversity’ from its policies

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mississippitoday.org – Molly Minta – 2024-11-21 14:32:00

The governing board of Mississippi’s public universities voted Thursday to delete the word “diversity” from several policies, including a requirement that the board evaluate university presidents on campus diversity outcomes.

Though the Legislature has not passed a bill targeting diversity, equity and inclusion initiatives in higher education, the Institutions of Higher Learning Board of Trustees approved the changes “in order to ensure continued compliance with state and federal law,” according to the board book

The move comes on the heels of the re-election of former President Donald Trump and after several universities in Mississippi have renamed their diversity offices. Earlier this year, the IHL board approved changes to the University of Southern Mississippi’s mission and vision statements that removed the words “diverse” and “inclusiveness.”

In an email, John Sewell, IHL’s communications director, did not respond to several questions about the policy changes but wrote that the board’s goal was to “reinforce our commitment to ensuring students have access to the best education possible, supported by world-class faculty and staff.”

“The end goal is to support all students, and to make sure they graduate fully prepared to enter the workforce, hopefully in Mississippi,” Sewell added.

On Thursday, trustees approved the changes without discussion after a first reading by Harold Pizzetta, the associate commissioner for legal affairs and risk management. But Sewell wrote in an email that the board discussed the policy amendments in open session two months ago during its retreat in Meridian, more than an hour away from the board’s normal meeting location in Jackson.

IHL often uses these retreats, which unlike its regular board meetings aren’t livestreamed and are rarely attended by members of the public outside of the occasional reporter, to discuss potentially controversial policy changes.

Last year, the board had a spirited discussion about a policy change that would have increased its oversight of off-campus programs during its retreat at the White House Hotel in Biloxi. In 2022, during a retreat that also took place in Meridian, trustees discussed changing the board’s tenure policies. At both retreats, a Mississippi Today reporter was the only member of the public to witness the discussions.

The changes to IHL’s diversity policy echo a shift, particularly at colleges and universities in conservative states, from concepts like diversity in favor of “access” and “opportunity.” In higher education, the term “diversity, equity and inclusion” has traditionally referred to a range of efforts to comply with civil rights laws and foster a sense of on-campus belonging among minority populations.

But in recent years, conservative politicians have contended that DEI programs are wasteful spending and racist. A bill to ban state funding for DEI in Mississippi died earlier this year, but at least 10 other states have passed laws seeking to end or restrict such initiatives at state agencies, including publicly funded universities, according to ABC News.

In Mississippi, the word “diversity” first appeared in IHL’s policies in 1998. The diversity statement was adopted in 2005 and amended in 2013. 

The board’s vote on Thursday turned the diversity statement, which was deleted in its entirety, into a “statement on higher education access and success” according to the board book. 

“One of the strengths of Mississippi is the diversity of its people,” the diversity statement read. “This diversity enriches higher education and contributes to the capacity that our students develop for living in a multicultural and interdependent world.”

Significantly, the diversity statement required the IHL board to evaluate the university presidents and the higher learning commissioner on diversity outcomes. 

The statement also included system-wide goals — some of which it is unclear if the board has achieved — to increase the enrollment and graduation rates of minority students, employ more underrepresented faculty, staff and administrators, and increase the use of minority-owned contractors and vendors. 

Sewell did not respond to questions about if IHL has met those goals or if the board will continue to evaluate presidents on diversity outcomes.

In the new policy, those requirements were replaced with two paragraphs about the importance of respectful dialogue on campus and access to higher education for all Mississippians. 

“We encourage all members of the academic community to engage in respectful, meaningful discourse with the aim of promoting critical thinking in the pursuit of knowledge, a deeper understanding of the human condition, and the development of character,” the new policy reads. “All students should be supported in their educational journey through programming and services designed to have a positive effect on their individual academic performance, retention, and graduation.” 

Also excised was a policy that listed common characteristics of universities in Mississippi, including “a commitment to ethnic and gender diversity,” among others. Another policy on institutional scholarships was also edited to remove a clause that required such programs to “promote diversity.” 

“IHL is committed to higher education access and success among all populations to assist the state of Mississippi in meeting its enrollment and degree completion goals, as well as building a highly-skilled workforce,” the institutional scholarship policy now reads. 

The board also approved a change that requires the universities to review their institutional mission statements on an annual basis.

A policy on “planning principles” will continue to include the word “diverse,” and a policy that states the presidential search advisory committees will “be representative in terms of diversity” was left unchanged.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Closed St. Dominic’s mental health beds to reopen in December under new management

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mississippitoday.org – Gwen Dilworth – 2024-11-21 13:54:00

The shuttered St. Dominic’s mental health unit will reopen under the management of a for-profit, Texas-based company next month. 

Oceans Behavioral Hospital Jackson, a 77-bed facility, will provide inpatient behavioral health services to adults and seniors and add intensive outpatient treatment services next year. 

“Jackson continuously ranks as one of the cities for our company that shows one of the greatest needs in terms of behavioral health,” Oceans Healthcare CEO Stuart Archer told Mississippi Today at a ribbon cutting ceremony at its location on St. Dominic’s campus Thursday. “…There’s been an outcry for high quality care.” 

St. Dominic’s 83-bed mental health unit closed suddenly in June 2023, citing “substantial financial challenges.”

Merit Health Central, which operates a 71-bed psychiatric health hospital unit in Jackson, sued Oceans in March, arguing that the new hospital violated the law by using a workaround to avoid a State Health Department requirement that the hospital spend at least 17% of its gross patient revenue on indigent and charity care.

Without a required threshold for this care, Merit Health Central will shoulder the burden of treating more non-paying patients, the hospital in South Jackson argued. 

The suit, which also names St. Dominic’s Hospital and the Mississippi Department of Health as defendants, awaits a ruling from Hinds County Chancery Court Judge Tametrice Hodges-Linzey next year. 

The complaint does not bar Oceans from moving forward with its plans to reopen, said Archer.

A hallway inside Oceans Behavioral Hospital in Jackson, Miss., is seen on Thursday, Nov. 21, 2024, during the facility’s grand opening. Credit: Eric Shelton/Mississippi Today

Oceans operates two other mental health facilities in Mississippi and over 30 other locations in Louisiana, Oklahoma and Texas. 

“Oceans is very important to the Coast, to Tupelo, and it’s important right here in this building. It’s part of the state of Mississippi’s response to making sure people receive adequate mental health care in Mississippi,” said Lt. Governor Delbert Hosemann at the Nov. 21 ribbon cutting.

Some community leaders have been critical of the facility. 

“Oceans plans to duplicate existing services available to insured patients while ignoring the underserved and indigent population in need,” wrote Hinds County Sheriff Tyree Jones in an Oct. 1 letter provided to Mississippi Today by Merit Health. 

Massachusetts-based Webster Equity Partners, a private-equity firm with a number of investments in health care, bought Oceans in 2022. St. Dominic’s is owned by Louisiana-based Catholic nonprofit Franciscan Missionaries of Our Lady Health System.

Oceans first filed a “certificate of need” application to reopen the St. Dominic’s mental health unit in October 2023. 

Mississippi’s certificate of need law requires medical facilities to receive approval from the state before opening a new health care center to demonstrate there is a need for its services. 

The Department of Health approved the application under the condition that the hospital spend at least 17% of its patient revenue on free or low-cost medical care for low-income individuals – far more than the two percent it proposed. 

Stuart Archer, CEO of Oceans Healthcare, speaks during the grand opening of Oceans Behavioral Hospital in Jackson, Miss., on Thursday, Nov. 21, 2024. Credit: Eric Shelton/Mississippi Today

Oceans projected in its application that the hospital’s profit would equal $2.6 million in its third year, and it would spend $341,103 on charity care.

Merit Health contested the conditional approval, arguing that because its mental health unit provides 22% charity care, Oceans providing less would have a “significant adverse effect” on Merit by diverting more patients without insurance or unable to pay for care to its beds. 

Oceans and St. Dominic’s also opposed the state’s charity care condition, arguing that 17% was an unreasonable figure. 

But before a public hearing could be held on the matter, Oceans and St. Dominic’s filed for a “change of ownership,” bypassing the certificate of need process entirely. The state approved the application 11 days later

Merit Health Central then sued Oceans, St. Dominic and the State Department of Health, seeking to nullify the change of ownership. 

“The (change of ownership) filing and DOH approval … are nothing more than an ‘end run’ around CON law,” wrote Merit Health in the complaint. 

Oceans, St. Dominic’s and the Mississippi Department of Health have filed motions to dismiss the case. 

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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How Mississippi’s Supreme Court Runoff Election Could Impact Criminal Cases

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mississippitoday.org – Caleb Bedillion, The Marshall Project and Daja E. Henry, The Marshall Project – 2024-11-21 11:00:00

Mississippi voters have dealt defeat to one conservative state Supreme Court justice and forced a moderate justice into a Nov. 26 runoff, with the final outcome possibly making the court more open to considering the rights of criminal defendants.

The nine-member court is largely conservative but justices have recently split in high-profile decisions that sharply affected state politics, including a ruling that shut down citizen-led ballot initiatives in Mississippi and allowed some state control over local criminal cases in its majority-Black capital. The court has also rendered rulings that have made the state increasingly unfavorable to defendants appealing their cases. 

“The ability of death row inmates in particular, and inmates in general, to access the courts has been recently curtailed significantly,” Matthew Steffey, a professor at Mississippi College School of Law, told The Marshall Project – Jackson and Bolts following the Nov. 5 election.  

Justice Dawn H. Beam joined the majority in those decisions, acquiring a reputation of being hostile to appeals by criminal defendants, and she ran for reelection this fall as the Republican Party’s favored candidate. However, she lost in the state’s 2nd District on Nov. 5 to David P. Sullivan, a defense attorney who has worked as a public defender.

Judicial races in Mississippi are nonpartisan and Sullivan has given few explicit signals about his judicial outlook. He has supported at least some criminal justice reforms and would be the third justice with experience as a defense attorney on this court. Some reformers nationwide have pushed for more professional diversity on the bench.

Even if Sullivan turns out to be more centrist or independent than Beam on criminal law, any overall shift in power on the court depends on the outcome of a runoff election next week. 

Two-term Justice Jim Kitchens and challenger Jenifer B. Branning will face each other in the Nov. 26 runoff election after neither won more than 50% of the vote on Nov. 5. The runoff will take place across the 22 counties that make up the Supreme Court’s central district, including Hinds County, home to Jackson. Throughout the campaign, the state GOP targeted Kitchens with attacks, while Branning, a Republican state senator with a conservative voting record, is endorsed by the party.

Kitchens is one of two reliably moderate-to-liberal high court justices. Justices from among an additional group of four sometimes veer away from the majority, as well, but can be more unpredictable, and this group does not vote as a bloc. 

Quinn Yeargain, a Michigan State University law professor who closely watches state courts, recently analyzed the court’s voting patterns and found Beam was consistently more conservative than Kitchens in recent cases. Yeargain told The Marshall Project – Jackson and Bolts that conservative and liberal voters often have few signals about how to select a candidate in judicial races. “It’s very hard to label the justices,” they said.


Sullivan — whose father was a Mississippi Supreme Court justice from 1984 to 2000 — called himself a “conservative” throughout his campaign. But he has also touted the value of judicial independence and criticized Beam for campaigning on her endorsement by the state Republican Party. 

“I think that rubbed a lot of people the wrong way,” Sullivan told the Sun Herald newspaper, speaking of Beam’s use of the endorsement. “Judicial races are nonpartisan for a reason. A judge’s impartiality could be called into question.”

Sullivan has broad legal experience, but much of his career has focused on private criminal defense while also doing some public defense work. He told The Marshall Project – Jackson and Mississippi Today that he supported a new administrative rule handed down in 2023 by the state Supreme Court to require continuous legal representation for poor criminal defendants from the beginning of their cases. An investigation by The Marshall Project, ProPublica and the Northeast Mississippi Daily Journal last year found, however, that many courts were unready at the time to implement the new representation rules.

During the campaign, Sullivan told The Marshall Project – Jackson and Mississippi Today that more work is needed to improve public defense.

Kitchens has also advocated for public defense reforms during his two terms on the court. He told a committee of legislators last year that the “playing field is far from level” between prosecutors and poor defendants.

On other criminal justice issues, he has sometimes dissented from opinions upholding death sentences. His decisions have scrutinized prosecutorial conduct and inadequate legal representation. 

Branning, the Republican senator, has a voting record on criminal justice issues that suggests a harsher approach toward criminal defendants. She has supported higher mandatory minimum sentences and reclassifying misdemeanors as felonies, has opposed expansion of parole and was among only a few lawmakers who voted against legalizing medical marijuana. 

She also supported increasing the jurisdiction of a controversial, state-run police force inside the majority-Black city of Jackson as well as increasing state control over many felony cases in Jackson. The Supreme Court unanimously curtailed much state power over these felony cases, but a majority left some control intact, with Kitchens and another judge dissenting.

Branning did not respond to questions from The Marshall Project – Jackson and Mississippi Today during the Nov. 5 campaign about her possible judicial outlook.

Kitchens was a prosecutor and then in private practice before joining the bench. Branning is a practicing attorney who typically handles civil cases. 

The winner of the Nov. 26 runoff will join Sullivan on a court that in recent years has been restricting the ability of people who say the legal system has wronged them to seek relief, legal experts told The Marshall Project – Jackson and Bolts this month. 

Krissy Nobile, director of the state’s Office of Capital Post-Conviction Counsel, said it’s become “increasingly more difficult to correct a wrongful conviction.” Her office provides legal counsel for indigent people on death row. 

She said a number of recent cases showed the barriers the high court has erected for criminal defendants appealing their convictions, and demonstrated indifference to civil rights violations. Kitchens disagreed with the majority, in full or in part, in all but one of the appeals, which the court unanimously denied.

In a case earlier this year, the Court ruled to monetarily fine an incarcerated person for filing any future post-conviction relief petitions that lacked merit. Kitchens joined a dissenting opinion condemning the fine. In another, the court denied a man who argued that his lawyers were ineffective and that they did not challenge prosecutorial misconduct or false forensic evidence presented by a medical examiner with a checkered past. The court’s majority denied the motion, and in the process, overturned a precedent that allowed ineffective counsel as an adequate reason to give a case another look in some types of appeals. Kitchens dissented, along with two other justices. 

“For decades in Mississippi, the Court held that it would correct errors if there was a violation (of) a person’s fundamental rights,” Nobile said. But she added this has changed considerably. Now, if you land a terrible lawyer who rushes your case, “You are out of luck,” she said, “even if your core constitutional rights have been clearly violated.” 

For the court’s majority, Nobile added, “The legal technicalities now trump a person’s constitutional rights.” 

Branning, left, and Kitchens at the Neshoba County Fair in August 2024. Credit: Eric Shelton, Mississippi Today

The runoff is the nation’s final supreme court race of the year. Thirty-two states held elections for their high courts earlier this year, resulting in a muddled picture, with liberals and conservatives each gaining ground in different places, Bolts reports

Mississippi’s runoff outcome will heavily depend on turnout and the composition of the electorate. In the Supreme Court’s central district, voters split narrowly between Democrat Kamala Harris and Republican Donald Trump in the presidential election on Nov. 5, but the runoff is just two days before Thanksgiving and will likely see a large dropoff in turnout. Branning received 42% of the vote in the first round, and Kitchens received 36%, with three other candidates making up the rest. 

There will also be a runoff the same day in the Gulf Coast area between Amy Lassiter St. Pé and Jennifer Schloegel for an open seat on the state Court of Appeals. The Court of Appeals hears both criminal and civil cases that have been appealed from lower courts. The Mississippi Supreme Court can hear cases directly on appeal or can assign cases to the Court of Appeals.

Observers agreed that against the national legal backdrop, neither a Kitchens victory nor a Branning victory would lead to a seismic change since neither outcome would flip the court’s conservative lean. Still, a modest shift could impact some of the most controversial cases, such as a rare 5-4 decision that upheld the death sentence in Willie Manning’s case

A Kitchens win, coupled with Sullivan’s upset earlier this month, would deal the Republican Party rare setbacks in a state where it has been dominant and could put moderate forces in a position to grow their numbers further in future elections. 

“You might end up with a normal conservative court,” law professor Yeargain said, “instead of one of the most conservative courts in the country.”

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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