Minnesota
A year after Minnesota became a trans refuge, ‘transplants’ make themselves at home
When bills to ban gender-affirming care for youth and adults were introduced in Texas last summer, Charley and his partner knew it was time to leave.
His move to Minnesota didn’t feel like moving in the traditional sense. It felt like fleeing.
“It was pretty clear that if that didn’t pass something else would,” said Charley, who is transgender. “We just needed to get out.”
Even the mere introduction of legislation caused some medical providers in Texas to preemptively cease offering care.
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MPR News agreed to identify Charley by first name only because he works as a graduate student at a university in Texas and fears possible workplace repercussions while completing his studies.
The couple put a list together of all the states that had passed protections for LGBTQ+ people. Then they looked at each state’s cost of living and different employment opportunities. Minnesota came out on top.
Just over a year ago, Minnesota became a legal refuge for transgender people after the Legislature passed a law cementing protections for trans people and those who offer gender-affirming care.
The move was aimed at countering efforts by dozens of conservative-led states that restricted access to care or banned it all together.
KFF, an independent health care policy tracking organization, reports that 24 states have limited access to the services for minors and 22 impose penalties for physicians that provide it. In the Midwest, Minnesota became an island for gender-affirming care. Iowa, North Dakota and South Dakota have enacted bans on care for youth.
The bans have spurred people like Charley to uproot their lives and move to Minnesota. And he’s not alone.
“This is a wonderful place to live. I’ve never felt like I could be more myself,” Charley said about Minnesota.
Nicole Neri for MPR News
Between July 2023 and March 2024, the pro-LGBTQ+ group called PFund said 231 people filled out a survey indicating that they have moved or are in the process of moving to Minnesota. But PFund notes that the number is likely higher.
Executive Director Aaron Zimmerman said it’s not easy to gather data at a large scale in this space. Some families and people moving to Minnesota for care might not need resources, ask for community support or seek out PFund as a resource.
Democrats who put forward and passed the legal changes in St. Paul said the numbers show the law has worked in bringing more people to Minnesota. But now, they say, the state needs to do more to offer communities for those who make the move.
Conservatives, meanwhile, said the step went too far and has tarnished the state’s reputation.
Demand for services grows
This increase in trans people and families in the state has caused a strain on the healthcare system and the providers that treat them. Children’s Minnesota saw a 30 percent increase in calls to the Gender Health Program in early 2023 as surrounding states began to ban gender-affirming care.
Before the Trans Refuge Law was passed, the waiting list for the Gender Health Program was over a year long. Dr. Angela Kade Goepferd, the program’s executive director, has only watched it grow.
“Our arms are already incredibly full,” Goepferd said earlier this year. “Our team at Children’s Minnesota and our colleagues in the Twin Cities who specialize in this essential health care are outmatched by the demand.”
Children’s Minnesota has hired two new clinicians as a part of the Gender Health Program to keep up with demand. The clinic now has six doctors. While interviewing candidates, at least half of the candidates were medical or mental health professionals looking to relocate to Minnesota from states where gender-affirming care bans for youth were in place.
Dr. Angela Goepferd is the executive director for Children’s Minnesota Gender Health Program.
Kerem Yücel | MPR News
“With essential health care for trans and gender diverse kids, nothing’s new,” Goepferd said. “We’ve been providing this care for decades, we’ve been using the same medications for decades, we’ve been following international guidelines that are now in their eighth revision and initially came out in the ‘70s. So this is not new care. The only thing that’s new about it is the controversy.”
Goepferd said misinformation surrounding gender-affirming care has been harmful and confusing for families with transgender youth. Transgender youth who are the targets of violence or harassment experience a negative impact on their mental health. The current political landscape has also made it more difficult for doctors like Goepfered to do their jobs.
“These are kids and families that are coming to us experiencing trauma,” Goepferd said. “We as a health care team are also experiencing trauma because we are personally targeted at times … we are a healthcare team that’s under stress, treating patients and families that are under stress and trauma.”
Gopeferd said the hope is that state lawmakers will pass funding to provide more resources for physicians and providers delivering care to transgender youth and adults.
‘Minnesota Transplants’ takes off
As Charley’s moving truck pulled up to his new home in St. Louis Park last August, he felt instant relief.
“It was really good to pull the Penske up into our neighborhood and already see the progress flags. That’s not something that I saw a lot in Texas, at least not in a suburban area,” he said. “Then just the feeling that winter was coming and the temperature was dropping. I got really excited because it was confirmation that I wasn’t in Texas anymore.”
His second emotion that would plague the next few months in his new home: loneliness.
“It felt like my partner and I were on our own little island,” Charley said. “There’s this whole community around us that we just sort of crash landed into, which was a really weird feeling.”
He began looking on local social media pages to try and find a social group to join. But there wasn’t a group in the Twin Cities dedicated to trans individuals who had moved to Minnesota.
So in January, Charley made his own. The Minnesota Transplants group offers a social network for new Minnesotans who are fleeing states that banned gender-affirming care — members of the group help each other move into their new homes and organize outings to explore their new city.
In four months, the group has grown to 40 members. They come from all over the country — many from Texas and Florida, Iowa and Wisconsin, even some from Alaska.
“Part of the goal of the group is to get people some kind of social life when they get here,” he said. “The shared understanding that we all have to be there for each other has been overwhelming, in a positive way.”
A new Capitol push
Rep. Leigh Finke, DFL-St. Paul, is the first openly trans lawmaker in the Minnesota Legislature and drove the trans refuge bill in the 2023 session. She is proud of the strides taken last year.
“So what we have done in Minnesota to make moves towards protection has really resounded,” Finke said. “Many people have come, organizations have built coalition’s around how we are going to support the community that’s already here, and the community that’s coming.”
But, Finke said, lawmakers have work left to do this year.
She said lawmakers should approve grant funding to help LGBTQ+ people and gender care providers relocate to Minnesota, along with other policy changes.
Rep. Leigh Finke, DFL-St. Paul, speaks at a rally at the Minnesota Capitol on Feb. 27. She says just because the trans refuge bill was passed, that doesn’t mean the work is done surrounding trans rights in Minnesota.
Dana Ferguson | MPR News
She’s also backing a constitutional equal rights amendment that guarantees access to gender affirming care and a bill that would mandate that insurance companies cover the cost, as well as a bill that would prohibit school boards or local governments from banning the display of rainbow flags.
“We can’t just pass the trans refuge bill and then think that we’re done,” Finke said. “We need to expand health care options, we need to make our schools safer, we need to do so much work to protect those people.”
While DFL majorities at the Capitol have advanced those proposals, they could be stymied by the arrest of Sen. Nicole Mitchell. Democrats hold a one-vote lead in the Senate and the policies could stall out if she resigns or is somehow barred from voting.
Conservative groups and Republicans at the Capitol have raised concerns about the policy change and the efforts to brand Minnesota a destination state for gender-affirming care.
“Forcing all insurers to pay for this is misguided and forcing all taxpayers to pay for so-called gender-affirming care is coercion,” said Rebecca Delahunt of Minnesota Family Council. “Children cannot give informed consent on treatment that alters or potentially changes their reproductive health.”
GOP lawmakers said they worry about how people elsewhere would perceive Minnesota after passing the trans refuge law and protections for those seeking abortions.
Rep. Matt Grossell, R-Clearbrook, is one of the GOP lawmakers who say worry about how others view Minnesota.
Monika Lawrence for MPR News
“I’m very saddened by what has been going on in our state Legislature here as of late turning Minnesota into a destination state for death or mutilation,” Rep. Matt Grossell, R-Clearbrook, said. “That is not the that is not the kind of reputation you want.”
While those comments or concerns permeate the national dialogue around gender-affirming care for transgender and gender diverse people, they don’t square with reality, physicians said.
Major medical associations support gender-affirming care and note it improves mental health outcomes in the short and long term. Providers also note that only in rare instances do transgender people under age 18 qualify for surgical treatments.
Settled in
Charley has lived in Minnesota for less than a year, but he already knows he wants to stay.
“This is a wonderful place to live. I’ve never felt like I could be more myself,” Charley said.
Charley has been talking with people across the country who want to form Transplants chapters in other states that have enacted laws similar to Minnesota’s trans refuge law. He wants to help create a blueprint for new chapters.
Colorado, Illinois, Maryland and New Mexico have all passed bills designed to shield transgender health care through legal protections, health care coverage and access.
He hopes one day there will be enough resources available for transgender people moving to Minnesota that the Transplants group does not have to exist.
Until then, he said the Transplants group will be ready to welcome them with open arms.
MINNEAPOLIS (FOX 9) – Gas prices are climbing again in the Twin Cities, with experts warning drivers to brace for more increases if oil prices keep rising.
Twin Cities gas prices see sharp increase
What we know:
According to GasBuddy’s survey of 1,106 stations, the average price for regular gasoline in the Twin Cities jumped 10.9 cents per gallon in the last week, now sitting at $4.18 per gallon. That’s 38.6 cents higher than a month ago, and $1.28 more than this time last year.
The national average price for gasoline also rose, hitting $4.48 per gallon after a 5.1-cent increase over the past week. Diesel prices are up too, with the national average at $5.62 per gallon, a 0.2-cent increase.
The cheapest gas in the Twin Cities was $3.70 per gallon Sunday, while the most expensive was $4.63 — a difference of 93 cents per gallon. Across Minnesota, prices ranged from $3.70 to $5.01 per gallon.
Patrick De Haan, head of petroleum analysis at GasBuddy, said, “Average gasoline prices declined in just six states over the last week, led by the Great Lakes region, where motorists in states like Michigan and Ohio saw prices fall sharply, while Indiana experienced even steeper relief after the state temporarily waived both its excise and use taxes on gasoline.”
GasBuddy’s data shows that while some states saw relief, most drivers are paying more at the pump.
Gas prices in neighboring states
By the numbers:
Gas prices in neighboring states and cities are also fluctuating. Wisconsin drivers are paying $4.37 per gallon, almost unchanged from last week. Sioux Falls saw a significant jump, with prices rising 17.3 cents to $4.13 per gallon. Minnesota’s statewide average is now $4.16, up 11.1 cents from last week.
Looking at the last five years, Twin Cities prices have varied: $2.90 per gallon in May 2025, $3.25 in 2024, $3.47 in 2023, $4.11 in 2022 and $2.76 in 2021. GasBuddy compiles these numbers from more than 11 million weekly price reports across over 150,000 gas stations nationwide.
How much more you’re paying at the pump
Dig deeper:
In the scenario that your vehicle has a 15-gallon tank that you fill up about every 10 days, here is a look at how much more it’s costing you in May versus April, and in 2026 versus last year.
Now: At an average price of $4.18/gallon at three times per month at $62.70 per trip, that comes out to $188.10
One month ago: An average price of $3.79/gallon at $56.85 per trip, that’s $170.55 per month.
One year ago: An average price of $2.90/gallon at $43.50 per trip, that’s $130.50 per month.
Drivers face more uncertainty ahead
What’s next:
De Haan said, “Those declines helped pull the national average lower by roughly eight cents over the last several days after oil prices eased mid-week on optimism that the U.S. and Iran could reach a deal. However, that optimism has since largely unraveled, with talks appearing to stall and President Trump signaling the latest proposal is unacceptable, helping push oil prices higher again in Sunday electronic trade.”
He warned that if oil prices continue to climb, the national average could approach $4.65 per gallon. Ongoing refinery issues are also affecting diesel production, especially in the Great Lakes region, where prices are nearing record highs.
Should geopolitical tensions escalate further, fuel prices could rise even more sharply in the weeks ahead, De Haan said. Many drivers are watching prices closely and hoping for relief, but experts say the outlook remains uncertain for now.
What we don’t know:
It’s unclear how long prices will continue to rise or when drivers might see relief at the pump. Future changes will depend on oil markets, refinery operations and global events.
The Source: This story uses information from GasBuddy.
Cori Roberts of St. Cloud, Minnesota, incurred more than $8,000 in medical bills after she was diagnosed at CentraCare with early-stage cervical cancer. She says the health system told her she made too much — about $41,000 a year — to qualify for financial aid.
Anthony Souffle/The Minnesota Star Tribune
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Anthony Souffle/The Minnesota Star Tribune
ST. CLOUD, Minn. — Cori Roberts was living in a rented basement four years ago when she was diagnosed with early-stage cervical cancer.
Recently divorced, the former stay-at-home mother had returned to work in her mid-40s, taking a human resources job that paid $41,000 a year. Then, despite having insurance, she was hit with more than $8,000 in medical bills.
“I had my car and a basket of clothes,” Roberts recalled. “Medical bills were not something I could have afforded.”
Roberts sought financial assistance from CentraCare, the St. Cloud-based health system that treated her. It’s a nonprofit charity that receives millions of dollars in federal, state, and local tax breaks. In exchange, it’s obliged to offer charity care to patients who can’t afford their medical bills.
But Roberts said CentraCare told her she made too much to qualify.
Roberts instead scrimped on groceries and Christmas gifts for her kids and paid off more than $6,000 over two years. Then CentraCare sued her last year because she hadn’t paid off all the debt.
“They’re supposed to be a nonprofit,” Roberts said. “It’s like, ‘Come on!’”
This story was a collaboration between KFF Health News and the Minnesota Star Tribune.
A sliver of financial aid
CentraCare earmarks just a tiny fraction of its budget for helping patients with medical bills they can’t pay, but it’s not alone in that, a Minnesota Star Tribune-KFF Health News investigation found.
Minnesota’s hospitals and health systems are among the least charitable in the country, the investigation found, providing less financial aid as a percentage of their operating budgets on average than hospitals in almost every other state.
The investigation drew on a detailed review of every hospital charity care program in the state, an analysis of five years of hospital financial data, and dozens of interviews with patients, hospital executives and state officials.
Nationally, hospitals spend an average of about 2.4% of their operating budgets on charity care, according to federal hospital data compiled by Hossein Zare, a researcher at Johns Hopkins University. Minnesota hospitals spend about a third of that, on average.
CentraCare’s flagship hospital in St. Cloud, Minnesota, earmarks only a fraction of its budget for helping patients who can’t pay their medical bills.
Anthony Souffle/The Minnesota Star Tribune
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Anthony Souffle/The Minnesota Star Tribune
Some spend considerably less. Of Minnesota’s 123 general hospitals, 62 devoted less than 0.5% of their operating budgets to charity care from 2020 through 2024, the Star Tribune-KFF Health News investigation found.
“The system is not working,” said Erin Hartung, director of legal services at Cancer Legal Care, a Minnesota nonprofit that helps patients with medical debt and other financial challenges. “And the burden is falling hardest on the people who are least able to bear it.”
CentraCare’s flagship St. Cloud Hospital spent less than 0.25% on charity care, according to the analysis. That works out to $25 in patient aid for every $10,000 spent on hospital operations.
A growing burden
Charity care will become even more vital in coming years as Americans lose health coverage or can’t afford rising copays and deductibles. The nation’s uninsured rate has been ticking up and is expected to increase further as budget cuts pushed by President Trump force states to pare back Medicaid and other safety net programs.
Nationwide, healthcare debt — much of it from hospitals — burdens an estimated 100 million people. And charity care, which was historically aimed at the uninsured, is now critical to many people with health insurance who can’t afford their bills.
Hospital officials say it’s unfair to expect them to solve this affordability problem when many of their facilities are financially strained. “No amount of charity care from hospitals will ever fully meet the needs of uninsured or underinsured Minnesotans. The need is simply too great,” Minnesota Hospital Association spokesperson Tim Nelson said in a statement.
But Minnesota Attorney General Keith Ellison said hospitals have a duty to increase charitable help for all needy patients in exchange for the tax breaks they receive.
“There is a benefit you get from being a nonprofit hospital in the state of Minnesota,” he said. “But do the people get the benefit?”
Several factors help explain why Minnesota hospitals provide so little financial aid. For one, job-based insurance and an expanded Medicaid program offer broad coverage. Hospitals in states with less government assistance and more uninsured people typically spend more on charity care.
Eligibility standards vary
But patients also face significant barriers accessing financial aid at many hospitals, including inconsistent eligibility standards and extensive applications, the Star Tribune-KFF Health News investigation found.
To qualify at many hospitals, patients must submit detailed personal information, including bank statements, retirement accounts, mortgage documents and estimates of other assets such as cars, homes or livestock.
Cori Roberts, who was sued by her healthcare provider after she was unable to make full payments for her treatment, thumbs through copies of her payment records at her home in St. Cloud, Minnesota.
Anthony Souffle/The Minnesota Star Tribune
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Anthony Souffle/The Minnesota Star Tribune
And because Minnesota has not standardized the criteria for charity care, patients might receive aid at one hospital but not another. The investigation found that some hospitals give free care to patients with an annual household income of $47,000, while others cap it at about $15,000.
There are similar variations in charity care standards at hospitals nationwide, KFF Health News and other researchers have found. A recent analysis by the nonprofit Lown Institute found that one hospital in Boston set the limit for free care at less than half the level as another hospital just a few block away.
In Minnesota, had Roberts driven 30 miles east or 35 miles north, she would have found medical providers with more generous financial aid policies than CentraCare. But she didn’t know to look.
Roberts, now 49, has remarried and lives in a split-level home in St. Cloud decorated with inspirational plaques such as “Faith, Family, Friends.” CentraCare recently dropped the lawsuit against her, but only after she took out a loan against her retirement plan to pay off the medical debt. “It just feels very unfair,” she said.
CentraCare spokesperson Karna Fronden said medical privacy laws prevented her from discussing Roberts’ case. She also declined interview requests about the health system’s charity care spending.
In a statement, Fronden said CentraCare provides assistance in addition to charity care, such as helping enroll patients in insurance. “This helps provide broader, longer-term protection for patients,” she said.
Other hospital leaders said they serve their communities in ways besides forgiving medical bills, including training doctors and nurses and preserving money-losing services such as obstetrics and mental health care.
Hospitals in rural communities specifically also play an important role as employers, said Robert Pastor, chief executive of Rainy Lake Medical Center in International Falls, Minn.
“We are the second- or third-largest employer in town, running on razor-thin margins while navigating escalating labor and supply costs and routine underpayment by public programs,” Pastor said. “Meanwhile, many health insurers post billions in profits.”
“Rural hospitals like ours are often portrayed as though we are sitting on piles of cash and simply choosing not to spend it on charity care. That is far from the reality,” he said.
Hospital executives say they have a responsibility to ensure that limited resources for charity care go to patients who need them, said Travis Olsen, chief executive of Hendricks Community Hospital, near the South Dakota border.
Burdensome application process
To determine eligibility, some Minnesota hospitals consider only income, the Star Tribune-KFF Health News investigation found. But most demand information about patients’ bank accounts as well. More than two-thirds require even more information, including the value of retirement accounts, life insurance policies, property and vehicles.
In addition to copies of tax returns, W-2 forms, pay stubs and bank statements, Hendricks asks aid applicants 53 questions about their finances. These include questions about the make, model and value of vehicles; the current market value of farm equipment, livestock and land; and the purchase price and square footage of homes.
Other hospital applications ask patients to detail their monthly spending on food, utilities and other medical bills.
All these questions discourage patients from seeking assistance, said Jared Walker, founder of Dollar For, a nonprofit that helps people apply for charity care.
“The drop-off rates are much higher the more questions you ask and the more documentation you have to provide,” he said.
By contrast, most hospitals make it very easy for patients to click a button on the hospital website to pay their bills, Walker said. “Hospitals have optimized to get payment,” he said. “If you want to get on a payment plan, if you want to get on a credit card, it’s so easy.”
Back in St. Cloud, Roberts said that when she drives past CentraCare’s $200 million expansion at its Plaza campus in St. Cloud, she wonders why Minnesota hospitals don’t live up to higher standards.
“They have all the money,” she said. “But they can’t grant a good person some grace?”
This story was produced by KFF Health News and the Minnesota Star Tribune.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF.
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