A new law blocking transgender Kentuckians from using Medicaid to cover some forms of gender-affirming health care goes into effect Friday — but will it actually be enforced?

It seems like no one knows for sure, leaving an untold number of LGBTQ+ individuals in limbo.

“Everything is a little unclear and we are preparing for the worst case scenario,” Chris Hartman, who leads the Fairness Campaign, told Queer Kentucky Wednesday. 

This year’s House Bill 495 sought to do two things aimed at the LGBTQ+ community: Undo Gov. Andy Beshear’s executive order banning “conversion therapy” in the state, and prohibit people on Medicaid from accessing some treatments tied to gender dysphoria. 

The part of HB 495 around “conversion therapy” went into effect upon the bill’s passage this spring, but the Medicaid piece is scheduled to go into effect alongside dozens of other new laws Friday. 

But, back in March, Beshear told lawmakers HB 495, along with nearly a dozen other bills, didn’t come with what his office believes to be necessary funding, and therefore, he shouldn’t be expected to implement it. 

“These holdings are simple: if the legislature creates a policy or program but does not provide  funding, it does not intend for the executive branch to perform those services over the biennium. The omission of an appropriation is the same as its elimination,” Beshear wrote at the time.

A fiscal analysis conducted by Beshear’s office estimated that HB 495 would cost the Medicaid program, partially funded by state dollars, an extra $6.3 to $9.8 million for “increased behavioral and mental health services for 5,000-10,000 persons.”

Reducing access to gender-affirming treatments and allowing the discredited practice of conversion therapy can lead to increased mental health issues for LGBTQ+ individuals, therefore potentially costing the state more for needing to cover additional counseling services and more psychiatric hospitalization.

Beshear’s letter did not differentiate between the two distinct pieces of HB 495. A spokesperson for Beshear’s office did not directly respond to questions as to whether or not the administration plans on implementing the Medicaid portion of the bill. 

However, no state funds are currently spent on “conversion therapy.” It is unclear how much, if any, state funds went to the discredited practice prior to Beshear’s September executive order banning the use of state dollars from covering it. 

The GOP-dominated legislature said in March they expect Beshear’s administration to enforce all of the laws they pass as written. Some GOP leaders went as far as to threaten Beshear’s budget and authority, should he not do what they say. 

“He won’t hire anybody, he won’t travel. He won’t do anything unless he gets authority from the legislature,” Senate President Robert Stivers told reporters at the time. 

Meanwhile, Kentuckians using Medicaid to cover gender-affirming health care like hormone therapies and puberty blockers are caught in the middle of the ongoing power struggle between Beshear and the legislature. 

Hartman pointed to the Kentucky Health Justice Network, which is expected to share options for “copayment assistance should it become necessary.”

He continued: “The Fairness Campaign is committed to doubling KHJN’s current transgender healthcare copayment fund as the need increases, and then we will assess where we are after things shake out in a few months. I hope our commitment will inspire other organizations and individuals to help underwrite any potential added costs to transgender Kentuckians’ healthcare due to the effects of House Bill 495.”