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State legislators across the US are considering bills related to medical access and participation in sports for transgender Americans. State-level hate crime protections can cover crimes related to a victim’s gender identity, but not always.

Lawmakers from at least 15 states have introduced bills aimed at restricting medical access or procedures for transgender minors. The bills include proposals to criminalize treatments and surgeries, require parental consent for medical care, and classify some medical procedures as child abuse.

Overriding a veto by Republican Governor Asa Hutchinson, the Arkansas State Legislature approved a bill in April that prohibits insurers from covering gender transition procedures for minors, the first state to do so.

Twenty-four states and Washington, DC, have laws or guidance from insurance regulators that prevent private insurers from denying coverage due to transgender status.

Most state legislatures also have bills related to the participation of transgender people in sports. In 2021, state legislators in 37 states introduced bills to limit participation in high school or college athletic teams based on “biological sex.”

Six states passed versions of these bills into law: Texas, Alabama, Arkansas, Florida, Mississippi, and Tennessee. Idaho passed a similar law in 2020.

A similar bill in Louisiana is waiting for a governor’s signature and another bill is awaiting a senate vote in Oklahoma.

Governors in Kansas and North Dakota vetoed similar bills, while related legislation is categorized as “dead” in Georgia and Texas legislatures.

In 2009, federal hate crime laws were expanded beyond race, color, religion, or national origin to include gender, disability, gender identity, or sexual orientation. Those standards apply only to federal cases, and states have varying statutes and definitions of who is covered under hate crime law.

All but two states — South Carolina and Wyoming — have their own hate crime statutes. South Carolina legislators are currently considering a hate crimes bill that includes protections for a “victim's race, color, sex, gender, national origin, sexual orientation, or physical or mental disability, regardless of whether the offender's belief or perception is correct.”

Fourteen states with hate crime statutes on the books do not make mention of sexual orientation, gender identity, or gender expression.

Thirteen states mention sexual orientation in their hate crime statutes, but do not explicitly mention gender identity or expression.

Hate crime laws in 21 states and Washington, DC, explicitly protect victims targeted due to actual or perceived gender expression or gender identity.