DAILY CALLER NEWS FOUNDATION—The Biden-Harris administration opened the door for a massive increase of taxpayer-funded transgender interventions, including child sex-change surgeries, and the Daily Caller News Foundation has obtained enough data to give a partial estimate of the cost.

From January 2018 to September 2023, 16 states spent more than $165 million funding “gender transition services”—including puberty blockers, hormones, and sex-change surgeries—with more than $45 million spent on interventions for children 17 and younger, according to data obtained by the Daily Caller News Foundation through a series of public record requests.

The DCNF asked states to provide reimbursement data for gender transition services covered through state insurance and medical assistance programs, such as the Children’s Health Insurance Program, which is funded through Medicaid.

The states were able to identify gender transition services through medical billing codes such as the International Classification of Diseases codes. Published by the World Health Organization, ICD codes provide comprehensive diagnostic information for diseases and injuries and create a valuable dataset used in medical research.

The DCNF requested the total amount of reimbursements paid for all gender transition services—which could include speech therapy and mental health services as well as life-altering surgeries—that were covered through state insurance and medical assistance programs.

The states that provided data to the DCNF include: Michigan, Idaho, Illinois, Virginia, Nevada, Wisconsin, Massachusetts, Louisiana, Maryland, New Hampshire, Wyoming, Kentucky, North Dakota, Oregon, Utah, and Washington.

The three states with the highest amount of reimbursements for gender transition services for adults and kids were Illinois, Oregon, and Washington state. Illinois spent $40,843,721, which included $14,296,558 in services for children 17 and under. Oregon spent $30,045,262 and Washington state spent $27,145,383. Other statewide totals for gender transition services include Maryland, which spent $11,849,062; Nevada, which spent $10,096,655; Michigan, which spent $6,821,169; and New Hampshire, which spent $2,360,534, according to data sent to the DCNF.

Virginia provided the DCNF with data from 2020 to 2022, spending a total of $13,933,635 on gender transition services in three years, with $3,480,492 spent on sex-change interventions for children 17 and under.

The state of Oregon specified that its data included reimbursement costs for a range of sex-change procedures, including surgeries, anesthesia costs, hair removal, speech therapy, hormone therapy, and puberty suppression.

The data showed a 60% increase in sex-change interventions for adults and kids under the Biden-Harris administration across the 15 states that provided yearly data totals for 2020 to 2022, jumping from $27,753,478 spent on gender transition services in 2020 to $44,553,052 in 2022. Utah did not break down its data into yearly totals and was excluded from this calculation. While data for 2023 was incomplete, 12 states provided some totals showing $22,017,362 had been spent on sex-change interventions over the first nine months of last year.

The DCNF attempted to obtain similar data from 48 states. However, many states outright denied the requests or sought exorbitant fees to obtain public data. For example, Rhode Island wanted a prepayment of more than $3,000 to fulfill the request that other states considered exempt from public information processing fees.

Explosion in Sex Changes for Minors 

Democrat-led policies that required insurers to pay for sex changes for minors led to an increase in the procedures nationwide, according to a leading transgender activist and physician.

In a June 2022 email exclusively obtained by the DCNF, Jason Rafferty, the lead author of the American Academy of Pediatrics’ sex-change policy, attributed the growth of pediatric sex-change surgery to services being more “accessible” due to increased Medicaid funding.

“I would say that there has likely been an increase in ‘top surgery’ among 16 and 17 year olds simply due to the fact that this surgery has become more accessible. 10 years ago when I started in this field, if a patient wanted surgery there was really only 1 surgeon in the region doing it for patients under 18 and aside from that they would need to travel across the country and pay out of pocket,” wrote Rafferty.

“Clearly if you were on Medicaid or did not have the resources, it was off the table. Today, we have 3 surgeons in [Rhode Island] doing these surgeries and probably half a dozen in [Massachusetts] plus a pediatric plastic surgeon at Boston Childrens specializing in gender surgeries. Most if not all now take Medicaid – very few patients are paying the fully cost of surgery out of pocket. So, the point is that my experience is not that surgery is ‘more popular’ but just more (or simply just) accessible,” he wrote.

Rafferty did not respond to multiple requests for comment from the DCNF.

The rapid growth of tax dollars funding the sex-change industry can be attributed to policies from Democrat presidential administrations.

In 2014, the Obama-Biden administration overturned a rule preventing Medicare from funding sex-change surgeries, opening the doors for taxpayers to pay for sex-change operations. It further expanded coverage for sex-change interventions in 2016 through its interpretation of Section 1557, a nondiscrimination provision of the Affordable Care Act.

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