JUNEAU — The Alaska House this week amended its draft budget to cut Medicaid funding for so-called optional treatments for gender dysphoria.

Multiple lawmakers said if the proposed cut is ultimately approved by the Legislature, it would likely not cut health care for transgender Alaskans. But that remains unclear.

Additionally, the Legislature’s attorneys warned the proposed cut to gender dysphoria care could be unconstitutional and unenforceable.

Rep. Sarah Vance, R-Homer, noted that the Alaska State Medical Board urged the Legislature in March to ban hormonal and surgical treatments for minors seeking to transition from one gender to another.

She said the cut would ensure taxpayer-funded coverage for gender dysphoria treatments are limited to only what is “medically necessary” and required by the courts.

In 2021, the state settled a class-action lawsuit that challenged the legality of excluding transgender Alaskans from health coverage related to their gender transitions. Now, that coverage through Medicaid is required.

Jennifer Martinez, a spokesperson for Planned Parenthood Great Northwest, said the organization believed that the proposed cut would likely not result in reduced Medicaid coverage for transgender Alaskans.

But if the cut is ultimately approved by the Legislature, Martinez said that Alaska’s Medicaid office would determine which treatments to cover. That could impact what she called “edge” treatments, such as follow-up surgeries for transgender Alaskans, Martinez said, but it remained unclear.

The intended cut to gender dysphoria treatments was approved on a 21-19 vote. Two Republican members of the Democrat-dominated majority — Reps. Chuck Kopp and Louise Stutes — joined the 19-member, all-Republican minority to approve the cut in the draft budget. All other members of the majority voted no.

Kopp amended the bill to state that optional psychiatric coverage would still be funded for children under age 18 who are experiencing gender dysphoria. He said those services could help “interdict” a child before they made “a life-altering, permanent medical decision.”

Anchorage independent Rep. Alyse Galvin, the mother of a transgender daughter, called the vote largely “political.” She said it would make transgender Alaskans feel “othered and hated.”

The amendment prompted passionate debate on the House floor.

Anchorage Democratic Rep. Andrew Gray, the first openly gay man to serve in the Alaska Legislature, opposed cutting Medicaid funding for transgender Alaskans, who he said are “one of the most marginalized, powerless minorities in our country.”

“I know what it was like to be a 16-year-old whose mother told you that you were wrong, that you were a mistake,” he added.

In response, Vance said the cut was about reducing the deficit. She told the House that it was not intended to suggest transgender children are “broken.”

“God doesn’t make mistakes,” Vance said on the House floor.

In 2021, the state estimated it would cost $28,000 per year to extend Medicaid coverage in Alaska for gender dysphoria treatments, Alaska Public Media reported.

Vance asserted on the House floor that gender dysphoria coverage through Medicaid costs the state $338,000 per year. But she didn’t know how much the state spends on treatments that are required by court order.

That dollar figure was shared with Vance’s office from the Alaska Division of Health Care Services. It represents Medicaid claims since July last year with a primary diagnosis indicating gender dysphoria, Vance’s staff said. But the $338,000 in Medicaid coverage includes funding from both federal and state sources, Vance’s staff added.

Ruth Botstein, the ACLU of Alaska’s legal director, opposed the amendment. She said medical decisions should be made by doctors, patients, and parents in cases involving minor children — not the Alaska Legislature.

”The American Medical Association, together with all other major medical organizations in the United States, supports gender-affirming care because it is medically necessary, evidence-based health care that is crucial to the health and well-being of people suffering from gender dysphoria and gender incongruence,” she said.

Rose O’Hara-Jolley, Alaska state director of Planned Parenthood Alliance Advocates, said the organization is “deeply disappointed” that the House approved “a harmful, performative amendment attacking gender affirming health care.”

“This amendment is rooted in bad faith. It aims to stir confusion, spread misinformation, and fuel fear within Alaska’s LGBTQ+ community,” O’Hara-Jolley said in a prepared statement. “We urge lawmakers to reject this amendment in the final version of the budget. All Alaskans — no matter their income or gender identity — deserve dignity, respect, and access to the care they need.”

Last year, the prior Republican-led majority spent days debating a transgender sports ban bill. But the measure was rejected by the Senate. In 2023, the Alaska School Activities Association banned transgender girls from competing on girls’ teams in high school sports.

Minority House Republicans separately tried to cut Medicaid funding in Alaska for abortions. But the minority’s proposal was rejected on a 20-20 vote. Stutes joined her colleagues in the Democrat-dominated majority to block the proposed cut.

Monday’s vote was the latest in a yearslong series of attempts by Alaska legislators to cancel public funding for abortion services. Prior votes have had little effect.

The Alaska Supreme Court has repeatedly ruled that the right to an abortion is protected by the state’s constitutional right to privacy. Additionally, the court ruled in 2001 that the state would violate the constitution’s equal protection clause and discriminate against poor women if it denied abortion services under Medicaid.

Budget amendment debates continued in the House on Tuesday. Once it is approved by the House, the operating budget next heads to the Senate for its consideration.