The description of gender-affirming care is “an individualized spectrum of social, psychological, and medical services that support people in aligning their physical expression of identity with their internal sense of gender.” Washington state law protects access to gender-affirming care for both youth and adults.
However, where do parents or youth turn to for it? Generally, major hospitals and children’s hospitals have supported these needs. Now, given federal funding restrictions and legal pressures, over forty major hospitals nationwide are being forced to end medical interventions for minors. While some may still offer mental health support, access to medications, hormone therapy, or other services is often being discontinued.
With the federal government recently blocking funding to Medicaid and the Children’s Health Insurance Program (CHIP) for gender-affirming medical care for minors — set to take effect on October 13, 2026 — the situation leaves youth vulnerable. States may opt to still pay for these treatments, but only by using their own money, and they would no longer receive federal matching funds. The new regulations have thus greatly impacted numerous programs that have either scaled back significantly or ultimately closed.
Safety Net Clinic
Recognizing the need to support these youth seeking care, a group of health professionals—pediatricians, physicians, and mental health therapists—met earlier in the year to determine how they might offer it. What they created became the Safety Net Clinic in Tacoma, WA, whose goal is to provide ethical, evidence-based, and compassionate support to young people during this period of disruption and uncertainty.
A letter addressed to community organizations states, “The Safety Net Clinic is an LGBTQ-led collective of volunteer healthcare professionals who have come together in response to the growing crisis in access to medically assisted gender-congruence care for youth in our region.”
During my recent interview with Dr. Ezekiel “Zeke” Melquist, MD, FAAP, he shared that many questions arose initially from parents and others, such as “How does it work with insurance?” His answer: “We don’t use insurance. It’s free.” Yes, you read that correctly: FREE!
Likewise, the clinic addresses the fact that gender-affirming care is always individualized. Its services will look different for everyone. It may be aligning one person’s physicality with their internal gender identity. For another , it may be medications, or even something as simple yet important as affirming their name in their perceived gender.
The process
You may ask, “At what age does gender-affirming care begin?” Generally speaking, it begins at puberty, usually around the age of 13. It is important to note, though, that if youth haven’t reached puberty, they wouldn’t receive medication, according to Dr. Melquist. Puberty varies and is assessed individually, with the clinic following national guidelines to help people get the care they need.
Clients first receive a physical and, after identifying their affirming goals, then meet with a mental health therapist, who drafts a letter of support that is then sent to the medical team. Parents are included in this process, and a client may begin medication, with regular blood tests, if agreed upon. Additional referrals are provided as needed.
Dr. Melquist stated that “thus far, there’s a fine line between getting the word out and encouraging youth to feel safe to access [services]. Youth may have privacy concerns and fears [about reaching] out.”
Luckily, community organizations such as the Oasis Youth Center and the Rainbow Center in Tacoma, provide logistical support, as does the Tacoma Needle Exchange. Oasis, founded in 1985, provides a safe place for Queer and questioning youth aged 11-24 to connect, learn, and grow. The Rainbow Center, now 29 years old, supports, educates, and celebrates the local Queer community. The Tacoma Needle Exchange, founded in 1988, offers crucial services, education, and an outreach team committed to harm reduction for all, community collaborations, and inclusion. These organizations assist youth in navigating the process and connecting them to the Safety Net Clinic when the time comes.
Information
To ensure privacy, the clinic uses a secure email address to connect to the team: allcare4allpeople@protonmail.com. Currently, it operates as a drop-in pop-up clinic on Fridays from 3:00 to 5:00 p.m. in downtown Tacoma.
Dr. Melquist stated that flyers are distributed to areas where Queer events are held and at Pride, and letters have been sent to various organizations. Now that school is back in session, the clinic plans to send letters and flyers to school counselors, as well as put up more posters throughout the community.
The clinic welcomes volunteers (both clinical and administrative) who are committed to supporting gender-diverse youth. Dr. Melquist is also a wonderful resource and pleased to answer any questions you may have. If you know someone who needs assistance, please don’t hesitate to contact the clinic.
Despite the federal guidelines limiting access to gender-affirming health care, youth and parents can rest assured that a dedicated healthcare team in Tacoma is mindful of the needs of gender-diverse youth. Their commitment created the Safety Net Clinic.
