Republicans in Maryland are criticizing Democratic lawmakers and Gov. Wes Moore for approving legislation that will expand taxpayer-funded Medicaid coverage to include transgender surgeries and drugs for children.

Under the old Maryland law, which is in effect until Jan. 1, 2024, Medicaid covers transgender surgeries and drugs for patients who were at least 18 years old and diagnosed with gender dysphoria. This includes mental health services, hormone replacement therapy, and gender reassignment surgery. The surgeries covered include genital alterations and alterations to male and female anatomy.

The new law removes the age requirements for transgender drugs and surgeries, which opens these procedures up to children. It also expands the number of services provided to both children and adults to include hair alterations, voice surgery, alterations to backsides, face and neck alterations, and fertility preservation services, among other things. It will also cover puberty blockers for children.

The legislation will also expand coverage to children and adults to include services related to detransitioning, which are treatments to help a person reverse transgender drugs and procedures.

Most Republicans opposed the legislation and fought to include amendments that would have prohibited Medicaid from covering sex change surgeries for children or at least required both parents to consent before a child could receive those services. The amendments failed, which means that doctors can perform these surgeries on children and prescribe the drugs as long as one parent or guardian consents.

“It is truly heartbreaking that lawmakers approved radical, often experimental, surgeries and medical castration to children under 18 years old. And taxpayers foot the bill,” Republican Del. Kathy Szeliga said in a statement provided to CNA.

Republican Del. Ryan Nawrocki expressed concerns about the irreversible effects that such procedures could have on children.

“Never in human history have there been experiments on children at this scale,” Nawrocki said in a statement. “Some in the medical community are experimenting on children with surgeries and pharmaceuticals that often leave children sterile. We are also seeing efforts in Annapolis to exclude parents from mental and physical health treatments given to their children who question their gender.”

Del. Bonnie Cullison, who co-sponsored the bill, said during a committee hearing that the legislation doesn’t change current practice related to minors and suggested that surgeries would remain rare.

“Most of the commercial insurance companies require the person to be 18 … for surgery,” Cullison said.

“The only time there’s an exception to that is when there is a clear and present danger to the young person because of their dysphoria. … No surgery would happen in less than a year’s time,” she said.

However, Republican Del. Brian Chisholm told CNA in an interview that there is “no real determination of what’s medically necessary.” He added that if a child gets started on puberty blockers, there is a much greater chance it will “progress to a much more dangerous surgery.”

“This bill’s going to be used to almost convince 13- to 18-year-olds that their life is going to be better if they just go on the puberty blockers,” Chisholm said.

In addition to Republican lawmakers, others have voiced concerns about the new law.

“The fact that the Human Rights Campaign has heralded Maryland Gov. Wes Moore’s signature of the Trans Health Equity Act speaks volumes,” Sarah Parshall Perry, a senior legal fellow at the Heritage Foundation, told CNA.

“These entirely elective procedures are already commonly covered by private insurance, but now taxpayers in the state will be forced to subsidize hormone therapy, hair alteration, voice therapy, physical alterations to the body, and fertility preservation,” Perry added.

The legislation comes at a time when several states have passed bills to prevent doctors from performing sex changes on children. More than a dozen states have banned surgical sex changes for children, some of which have also banned drugs that facilitate sex changes for children.

As of May, most states still allow sex change operations to be performed on children.