This story was published in partnership with RANGE Media, Spokane’s independent, worker-owned press for the people. Sign up for RANGE’s newsletter here.

Avery Ellis wasn’t born in Idaho, but it is the state he calls home. 

It’s the state where he came out first as gay, then as transgender. It’s the state where he first performed drag, under the name Tom from Accounting. It’s the state where he found and built queer community. It’s the state where he met his partner, and where he started medically transitioning. 

But last October, Ellis was left to wonder if his state would ever care for him like he cared for it.  

Because of a new state law, his state insurance refused to cover his prescribed doses of testosterone. Now, Ellis is fighting to access gender-affirming care in a place that he loves. If he lived just hours away, in Washington, things could be different — at least for now. 

But transgender people across the country — even in blue states considered sanctuaries — could soon find themselves facing the same hurdles as Ellis in Idaho if President Donald Trump fulfills campaign promises to prevent Medicaid funds from being used to pay for gender-affirming care. 

‘I had to out myself as trans at the pharmacy.’

Ellis moved from South Carolina to Twin Falls, Idaho, in 2016 — the beginning of Trump’s first term in office — and started connecting with the LGBTQ+ community. Idaho isn’t most people’s idea of a gay mecca, but he met more queer people in this city of just over 50,000 people than he ever had in South Carolina. 

“I was able to get the courage to come out as myself,” Ellis told RANGE. By 2022, Ellis said he was ready to begin transitioning and, between then and late 2024, he received gender-affirming care using the state’s Medicaid plan with no issues. 

That care consisted of hormone therapy. He took regular doses of testosterone, which he received through the pharmacy of Planned Parenthood Twin Falls — one of just two Planned Parenthood locations in Idaho, which has since closed to all in-person appointments and now provides telehealth care only. 

Ellis described the feeling of taking testosterone as “finally becoming myself.” But in the fall of 2024, that access to care was feeling exceedingly tenuous as the political climate in Idaho became more unfriendly towards transgender people.

“It always feels like any moment could be the last moment I have access to [gender-affirming care],” Ellis said. “And for that to possibly get taken from me is a very terrifying experience.” 

Earlier that year, the Idaho legislature had passed House Bill 668 — signed into law by Governor Brad Little in March 2024 — which would prevent any public funds, including Medicaid state insurance dollars, from being used “for gender transition procedures.” 

The prescription of testosterone itself wasn’t banned, but any treatment “to affirm the individual’s perception of [their] sex in a way that is inconsistent with [their] biological sex,” was.

Because he used state insurance to pay for his testosterone, Ellis was hyper-aware of the law, but until late October, he’d still been able to receive free care. The law went into effect July 1, and somehow, Ellis had slipped under the radar. 

On October 23, that changed. 

When Ellis went to his pharmacy to pick up his testosterone, the pharmacist asked a new question: “Are you male, female or nonbinary?”

Ellis answered truthfully, but because that was inconsistent with the “female” sex he had to list on his Medicaid registration, the pharmacist was unable to fill his prescription. 

“I had to out myself as trans at the pharmacy,” Ellis said. It was uncomfortable and humiliating, he said.

If Ellis was a cisgender man using prescribed testosterone, he said, the pharmacist would have been able to issue an override. But because Ellis was transgender, he was without care.

A warning for Washington

Just across the state border in Washington, the harsh realities of seeking gender-affirming care in a red state like Idaho can feel lightyears away; in 2022, the state legislature passed the Gender-Affirming Treatment Act, which “prohibits health plans from denying or limiting coverage for gender-affirming treatment.”

But advocates worry that Trump could still use the Idaho law, and the nine others like it that prevented Ellis from accessing care as the playbook for restricting access across the country, even in blue states where care is currently covered by Medicaid.

Trump made promises during his campaign that he would prohibit Medicaid — the nationwide health insurance program for low-income Americans — and Medicare, federal health insurance for Americans 65 and older, funding from going to any health care providers that offer gender-affirming care. This could impact the 20% of transgender adults who receive insurance coverage through Medicaid nationally. 

In his first few weeks in office, Trump hasn’t yet done that, but he has signed a rapidfire slate of other anti-transgender executive orders, including one that cut access to insured gender-affirming care for the children of military members. 

On January 28, he signed an executive order taking aim at gender-affirming care for people under the age of 19 and asking the Department of Health & Human Services to take regulatory actions, including turning off access to Medicaid funds from the federal government. Trump has also banned transgender people from military service and trans athletes from women’s sports. Even the word “transgender” has been scrubbed from federal websites, along with critical information and datasets about transgender care.  

Because all state insurance programs use federal Medicaid dollars alongside state monies, the federal government under Trump could refuse federal payments for health care procedures frequently under political fire, like gender-affirming care and reproductive health care, or refuse to provide any Medicaid dollars at all to states that require insurance to provide the services.

In Washington, federal dollars pay for between 50 percent and 90 percent of the costs for services provided by Apple Health — Washington’s state insurance program that utilizes Medicaid funds — depending on if they fall under traditional Medicaid or the expansion created under the Affordable Care Act. This reliance on federal funds creates a vulnerability that Trump’s administration has already shown a willingness to exploit, as he has threatened to shut off the valve of federal funding to hospitals that provide gender-affirming care for people under 19 and schools that allow students to “socially transition.”

Washington state Sen. Nicole Macri, co-chair of the Legislative LGBTQ Caucus and legislative advisor to the state’s LGBTQ Commission, told RANGE that because Washington state law guarantees gender-affirming care, it’s not going to disappear overnight as the result of a Trump order. But ensuring continued protection “comes down to a funding issue,” because Washington currently has a multi-billion dollar budget hole. 

While the current budget is balanced through June 2025, the state’s projected spending is set to vastly outpace tax revenue, and departments will certainly face cuts. What those cuts are and in which departments is up in the air as both a new governor and a new legislature braces for the end of the currently balanced budget. 

If the federal government cuts its half (or more) of the funding, the burden would shift to Washington. With tight budget constraints, Macri said it’s unclear how the state could make up the difference and maintain its legal obligation to pay for care.

If Trump follows recommendations in conservative policy blueprint Project 2025 to cut Medicaid matching payments for all services in states that allow recipients to receive reproductive or gender-affirming care, it would become an even tighter squeeze for Washington. In his opening salvo in office, Trump has already begun to bring Project 2025 to fruition, including appointing the architect of Project 2025 to lead the Office of Budget and Management. 

Because Washington has seen higher levels of Medicaid enrollment and tax revenue that’s lagging behind inflation, Macri said she doesn’t “have clarity,” about what lawmakers will do if they’re left on the hook for the insurance payments. The lack of certainty and whirlwind of action from the administration has made creating a firm response plan difficult, and “could be devastating to our state budget,” Macri said. In one potential scenario, she fears Trump could threaten to pull Medicaid matching payments for any procedure for states that mandate gender-affirming care coverage.

“They’re making all sorts of threats,” she added. “We don’t know how they’re going to play out or how quickly.” 

The uncertainty and the sheer speed at which the Trump administration is moving — signing 35 executive orders in his first week alone — has left transgender Americans panicking. 

Crisis hotlines saw record numbers of calls from LGTBQ+ youth just days into the Trump administration. Transgender people raced to secure necessary documentation like passports. Families prepared to move to friendlier states, or even countries. 

In Spokane, LGBTQ+ justice nonprofits like Spectrum Center have seen an influx in requests for resources, financial help and emotional support, the group’s Director of Advocacy KJ January told RANGE. “ We have just random emails that are like, literally just like, ‘I’m scared. I don’t know what to do.’” 

Spectrum Center opened applications for their Gender Affirming Products Program — which funds gender-affirming products and services like legal name changes, passport application fees, clothing, haircuts and more — on January 22. They had the money to pay around $300 for up to 50 recipients, January said. 

Within three days, all the slots were filled and a waitlist had been created. 

Even for the organizations uniquely prepared to help, it’s a struggle. January said that Spectrum, which receives some state funding, fears that funding opportunities could dry up — at the state level because of Washington’s budget deficit, at the federal level because of attacks on DEI and at the individual level because if economic conditions worsen under Trump’s proposed tariffs, individuals may have less to give. This could leave Spectrum fighting other progressive nonprofits for a limited pool of funding. 

And, she added, it’s so hard to know what to tell people in crisis when she doesn’t “know what tomorrow is going to look like. It’s terrible, and it just compounds.” 

For Ellis in Idaho, the state government feels hostile as well, starting their legislative session by passing an official request that the Supreme Court to overturn gay marriage. 

“My newsfeed is exhausting,” Ellis told RANGE. “Watching my life be questioned and demeaned by a very vocal group of people is scary and very exhausting.”

Contingency and crisis planning

Though the federal government has the power to put blue states like Washington in check by taking money off the board, it’s not a checkmate — yet. 

Macri said that despite “ the level of concern and panic that is reverberating,” throughout the state, there are a lot of reasons for Washingtonians and other blue state residents to stay hopeful. Depending on what method Trump uses if or when he comes for Medicaid-funded gender-affirming care, action will likely get tied up in courts, which means care won’t vanish immediately.

State officials have been preparing alongside advocates for “the range of threats,” and strategizing about mitigation possibilities. 

Even in the worst case scenario of complete lockdown of Medicaid funds, Washington state law still requires gender-affirming care to be paid for by insurance. That law would have to be overturned by state lawmakers before people could legally lose access to their care — 23 other states and Washington, D.C. have similar nondiscrimination laws.

And queer people have strong allies in state government right now, Macri said —  “strong Democratic majorities [who] have been big champions for LGBTQ Washingtonians.”

Nationally, queer organizations are preparing to legally challenge Trump’s transphobic policies. Two LGBTQ+ groups have already filed a joint lawsuit against his order that prevents transgender people from serving in the military.

And in Spokane, organizations like Spectrum are jumping into action to build coalitions, like their new Rapid Response Team that’s preparing to mobilize queer people and allies against anti-queer policies that could come down the pipeline locally, statewide or nationally by providing information and action opportunities, like testifying at city council meetings or the state legislature. 

Odyssey Youth Movement — a community center and organization serving LGBTQ+ youth — hosted a Valentine’s Day Ball at Spokane gay bar Nyne to gather community and raise funds to support their programming. 

But in Idaho, Ellis feels stuck on an island. Since Medicaid stopped covering his care, his access to testosterone has been in flux. Some months, he’s paid out of pocket for it. With the service GoodRX, Ellis said that cost him $35, but he lives paycheck to paycheck: $35 is a tank of gas, or a trip to the grocery store.

 “Some months I don’t know if I’ll be able to afford an extra $35,” Ellis said. 

Now, he has new insurance, but because Idaho has no requirements that insurance cover gender-affirming care, he isn’t confident it will continue to cover his hormone therapy in the current political climate. 

His therapist recommended he move out of the state, but Ellis is stuck. 

“I’m poor, so my contingency plan is based around what I can afford,” Ellis said. “Even though it’s scary living in Idaho, I just don’t have the ability to move to a safer state.” 

He’s left with an impossible choice: “Buckle down and make a decision on if I want to live out and proud and be a beacon of hope,” or conceal himself and go back in the closet.