Nebraska Requires 40 Hours of Therapy, 7-Day Wait Before Trans Kids Can Start Medication

A political appointee of Nebraska Gov. Jim Pillen (R) used emergency regulations to require transgender minors to get at least 40 hours of “gender-identity-focused” therapy before receiving any gender-affirming medical treatments. The regulations also impose a mandatory seven-day waiting period after the therapy is completed before patients can start taking gender-affirming medications like puberty blockers or hormone treatments. It’s not entirely surprising that conservative lawmakers are using the anti-abortion playbook to attack trans people, but it’s still vile.

A law that took effect on Sunday bans gender-affirming surgeries for everyone under the age of 19—yes, the state considers even 18-year-olds to be minors— and requires the state’s chief medical officer, Timothy Tesmer, to determine the rules for how new patients can access non-surgical care. Tesmer is a Pillen appointee who is an ear, nose, and throat doctor, notably not a specialty that provides gender-affirming care.

Tesmer wrote emergency regulations rather than final ones and the state Department of Health and Human Services announced Sunday that Pillen approved them and said they are in effect for 90 days. A proposal for a permanent set of rules will be released by the end of the month and a public hearing will be held on November 28 in Lincoln. This all begs the question of why the state even bothered to release regulations now…unless the intent was to just terrorize trans people and their families. (The emergency regulations were posted online along with an FAQ from the department.)

Nebraska’s gender-affirming care restrictions passed in May with a 12-week abortion ban attached. (Republicans pulled that maneuver after a six-week abortion ban failed to pass on its own.) It’s a little on the nose that lawmakers combined bills on these topics. For decades, anti-abortion activists have attacked access to the procedure using health regulations: They passed things like waiting periods, biased counseling, parental consent, bans on public and private insurance coverage, and unnecessary building regulations. Lawmakers are using the same playbook to attack gender-affirming care—first for minors, then for everyone.

It’s two sides of the same fucked-up coin.

Independent journalist Erin Reed noted that it could take months for someone to hit the 40 hours of therapy required, as it’s limited to an initial consult of up to four hours, then a maximum of two hours per week. That’s if they can even find a therapist who meets the state’s requirements. The FAQ said that the seven-day waiting period after the therapy is “necessary to allow the patient and the patient’s family enough time to weigh the risks and benefits of treatment”—as if the young person wouldn’t have been considering it for months at that point. No, it seems like these rules are designed to effectively cut off minors’ access to any gender-affirming care.

Grant Friedman, a legal fellow for the American Civil Liberties Union of Nebraska, said the new regulations were unnecessary because medical providers already follow international standards of care. “These are decisions to be made between patients, parents, providers,” and not politicians, Friedman told the Associated Press.

At least 22 states have passed laws restricting access to gender-affirming care and it’s only a matter of time until the Supreme Court gets involved.