Missouri Republican Gov. Mike Parson has signed a bill into law prohibiting trans minors and some adults from gender-affirming medical treatments designed to treat gender dysphoria.

Under the law, signed by Parson on June 7 and taking effect on Aug. 28, Missouri health care providers will be barred from prescribing puberty blockers, hormones, or gender confirmation surgery — the latter of which rarely is prescribed for those under 18 — to minors.

Trans adults who are seeking out gender-affirming care will not be prevented from accessing it, and doctors are permitted to prescribe certain treatments, but must either have private or employer-based insurance willing to cover the cost of such procedures, or be willing to pay out of pocket. Under the law, Medicaid will be barred from covering the costs of any medical treatments intended to facilitate a person’s gender transition.

Additionally, incarcerated persons will not be eligible to receive gender-affirming surgery, although Missouri is currently bound by a federal court decision, which found that the state Department of Corrections’ “freeze-frame” policy — in which transgender individuals were prohibited from receiving hormone therapy unless they had started it prior to their incarceration — was unconstitutional. 

The laws contains an exception allowing transgender minors who have already started gender-affirming treatments prior to the law’s passage to continue receiving such medical care.

Parson also signed a law barring transgender athletes in grades K-12 and at the collegiate level from competing on female-designated sports teams. Schools found in violation of the law can be stripped of all state funding as punishment. 

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Both the ban on gender-affirming care and the ban on transgender athletes will expire in 2o27, as part of a compromise negotiated with Democrats in the State Senate, according to the Associated Press. Parson had previously threatened to call a special legislative session if neither bill was passed before the end of the regular 2023 session, on May 12. But Senate lawmakers disagreed with their House colleagues on how restrictive the bans should be, resulting in the selection of 2027 as a sunset date for the legislation.

Missouri is the 19th state to pass a law banning all forms of gender-affirming care for minors — part of a larger trend that has seen Republican lawmakers in various states propose multiple bills seeking to limit transgender rights, allow detractors to claim religious exemptions to affirming LGBTQ people’s identities, or severely restrict expressions of LGBTQ identity in public. 

It remains to be seen whether opponents of the new laws will bring a lawsuit against the state seeking to block them from being enforced.

Missouri’s Planned Parenthood clinics have been holding pop-up clinics to start patients on treatments before the law takes effect. 

“We will continue to do everything in our power to ensure all patients are supported, seen, and cared for,” Yamelsie Rodríguez, the president and CEO of Planned Parenthood of the St. Louis Region and Southwest Missouri, told NBC News in a statement. “Any patient wanting to continue their gender-affirming care in a state that welcomes people of all identities: our Fairview Heights, Illinois, health center is open to you and we are here to help you make plans to get care.”

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Missouri Republican Attorney General Andrew Bailey, who is currently running for re-election, launched an investigation earlier this year into St. Louis’ Washington University Transgender Center, based on clams from a former staffer alleging that doctors were prescribing hormones to minors too quickly and without providing sufficient mental health services to patients prior to starting treatment.

An internal review by Washington University later concluded that “physicians and staff at the Center follow appropriate policies and procedures and treat patients according to the accepted standards of care, as recommended by the American Academy of Pediatrics and other nationally recognized organizations.”

In April, Bailey sought to implement an “emergency rule” that would have required adults and minors to wait for three years, and undergo at least 18 months of “talk therapy” before receiving gender-affirming treatments. The rule also sought to require medical providers to continuously certify that their patients continue to suffer from ongoing gender dysphoria, certify that patients are not autistic, and treat any other existing mental co-morbidities before prescribing any gender-affirming treatments.

Civil liberties advocates and LGBTQ rights groups blasted the rule at the time, accusing Bailey of overstepping his authority by imposing a ban that the legislature had not yet approved.

A St. Louis judge subsequently blocked the attorney general’s rule, which Bailey later withdrew after legislative lawmakers passed the bill that Parson signed into law.

Bailey recently attempted to enlist the police force in Kansas City in enforcing the ban on transition-related treatments, in response to the Kansas City Council’s approval of a measure establishing the city as a “sanctuary” for those seeking out gender-affirming care. Under the city’s resolution, police and legal personnel are directed to de-prioritize enforcing the ban in favor of other duties, and the city will not prosecute or fine those found in violation of the law.

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But Kansas City Police Chief Stacey Graves has rejected Bailey’s entreaties, noting that there are no criminal penalties for violators, thereby taking the issue out of the hands of police officers.

“Based on the nature of the proposed changes in the law, the police department plays no role in these law changes because the provisions do not pertain to criminal conduct, but rather seeks enforcement through medical licensing and civil action,” Graves said in a statement.

In a move similar to the Kansas City Council, St. Louis Mayor Tishaura Jones recently signed an executive order ensuring the city adopts policies to support the transgender community. That order directs the city’s Department of Health to coordinate the “collection and dissemination” of “medically accurate” information on gender-affirming care, including how and where residents may access such services — which, for some, includes seeking treatment outside of Missouri.

Although doctors may not prescribe such treatments to minors in state, Jones’s executive order rests on the premise that the law signed by Parson doesn’t restrict providing information about gender-affirming care, or assisting others in traveling outside of Missouri to receive such treatments. Proponents of the order argue that the dissemination of such information is considered a form of free speech, which would be protected by the First Amendment to the U.S. Constitution.