COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.:3009H.03C Bill No.:HCS for HB Nos. 1520, 1519, 2355 & 2357 Subject:Children and Minors; Health Care; Health Care Professionals Type:Original Date:February 1, 2024Bill Summary:This proposal modifies provisions relating to gender transition procedures.
FISCAL SUMMARY
ESTIMATED NET EFFECT ON GENERAL REVENUE FUNDFUND AFFECTEDFY 2025FY 2026FY 2027Total Estimated Net
Effect on General
Revenue $0$0$0
ESTIMATED NET EFFECT ON OTHER STATE FUNDSFUND AFFECTEDFY 2025FY 2026FY 2027Total Estimated Net
Effect on Other State
Funds $0$0$0
Numbers within parentheses: () indicate costs or losses. L.R. No. 3009H.03C
Bill No. HCS for HB Nos. 1520, 1519, 2355 & 2357
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ESTIMATED NET EFFECT ON FEDERAL FUNDSFUND AFFECTEDFY 2025FY 2026FY 2027Total Estimated Net
Effect on All Federal
Funds $0$0$0
ESTIMATED NET EFFECT ON FULL TIME EQUIVALENT (FTE)FUND AFFECTEDFY 2025FY 2026FY 2027Total Estimated Net
Effect on FTE 000
☐ Estimated Net Effect (expenditures or reduced revenues) expected to exceed $250,000 in any
of the three fiscal years after implementation of the act or at full implementation of the act.
☐ Estimated Net Effect (savings or increased revenues) expected to exceed $250,000 in any of
the three fiscal years after implementation of the act or at full implementation of the act.
ESTIMATED NET EFFECT ON LOCAL FUNDSFUND AFFECTEDFY 2025FY 2026FY 2027Local Government$0$0$0 L.R. No. 3009H.03C
Bill No. HCS for HB Nos. 1520, 1519, 2355 & 2357
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FISCAL ANALYSIS
ASSUMPTION
§§191.1705 & 191.1720 - "Missouri Save Adolescents from Experimentation (SAFE) Act" and
gender transition procedures
In response to a similar proposal from this year (HB 1519), officials from the Department of
Labor and Industrial Relations (DOLIR) noted:
The proposal states that no health care institution, health care professional, or other person shall
be required to perform, assist, or participate in medical procedures, treatments, counseling, Rx,
or surgeries related to sex reassignment or gender identity transitioning if such procedures, et al.,
are contrary to the established policy of, or the moral, ethical, or religious beliefs of, such health
care institution, health care professional, or other person.
No cause of action shall accrue against any such health care institution/professional/other person
on account of such refusal to perform. No person or institution shall be denied/discriminated
against in the receipt of any public benefit or denied or discriminated against in any public or
private employment by any means on the grounds that the person or institution refuses to
perform such medical procedures. Any person who shall deny or discriminate against another
shall be liable to the party injured in an action at law, suit in equity, or other form of redress.
It is assumed that the Missouri Commission on Human Rights (MCHR) could absorb the
increase in complaints with existing resources. However, if the number of additional cases was
significant or additional legislation was enacted which increased other types of MCHR
complaints, the impact could be substantial enough that the MCHR could not absorb additional
work without additional resources and would request such through the appropriations process.
Oversight notes the officials from the DOLIR assume it could absorb the costs related to this
proposal. If multiple bills pass which require additional staffing and duties at substantial costs,
DOLIR could request funding through the appropriation process. Oversight does not have any
information to the contrary. Therefore, Oversight will reflect a zero impact in the fiscal note.
Officials from the Office of Administration - Administrative Hearing Commission, the
Department of Elementary and Secondary Education, the Department of Social Services,
the City of BridgetonKansas City, the City of O’Fallon and the City of Urich each assume
the proposal will have no fiscal impact on their organization.
In response to a similar proposal from this year (HB 1519), officials from the Newton County
Health Department and the Department of Health and Senior Services each assume the
proposal will have no fiscal impact on their organization. L.R. No. 3009H.03C
Bill No. HCS for HB Nos. 1520, 1519, 2355 & 2357
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In response to a previous version, officials from the Attorney General’s Office the Department
of Commerce and Insurance, the Missouri Department of Conservation, the Missouri
Department of Transportation and the Missouri Consolidated Health Care Plan each
assumed the proposal will have no fiscal impact on their respective organizations.
In response to a similar proposal from last year (SB 49), officials from the Office of the State
Courts Administrator assumed the proposal will have no fiscal impact on their organization
Oversight does not have any information to the contrary. Therefore, Oversight will reflect a zero
impact in the fiscal note for these agencies.
Officials from the Department of Public Safety - Missouri Highway Patrol defer to the
Missouri Department of Transportation for the potential fiscal impact of this proposal.
FISCAL IMPACT – State GovernmentFY 2025
(10 Mo.)
FY 2026FY 2027$0$0$0FISCAL IMPACT – Local GovernmentFY 2025
(10 Mo.)
FY 2026FY 2027$0$0$0
FISCAL IMPACT – Small Business
Small business health care providers could, under circumstances outlined in the proposal, be
subject to administrative discipline or taken to court as a result of this proposal.
FISCAL DESCRIPTION
The proposed legislation appears to have no direct fiscal impact.
This legislation is not federally mandated, would not duplicate any other program and would not
require additional capital improvements or rental space.
SOURCES OF INFORMATION
Attorney General’s Office
Department of Commerce and Insurance
Department of Elementary and Secondary Education L.R. No. 3009H.03C
Bill No. HCS for HB Nos. 1520, 1519, 2355 & 2357
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Department of Public Safety - Missouri Highway Patrol
Department of Social Services
Missouri Department of Conservation
Missouri Department of Transportation
Missouri Consolidated Health Care Plan
Office of the State Courts Administrator
Department of Labor and Industrial Relations
Department of Health and Senior Services
City of Bridgeton
Kansas City
City of O’Fallon
City of Urich
Julie MorffRoss StropeDirectorAssistant DirectorFebruary 1, 2024February 1, 2024