Ohio SAVE Act: Prohibitions, Medicaid, and Athletics Rules

The Ohio SAVE Act, short for Saving Adolescents from Experimentation, took effect on April 24, 2024, after the legislature overrode Governor DeWine’s veto of House Bill 68. The law bars Ohio physicians from providing gender reassignment surgery, cross-sex hormones, or puberty-blocking drugs to anyone under 18 for gender transition purposes, adds parental consent and screening requirements for mental health care of minors with gender-related conditions, prohibits Ohio Medicaid from covering gender transition services for minors, and requires K-12 and college athletic teams to be separated by biological sex. The medical provisions live in Chapter 3129 of the Ohio Revised Code; the athletics provisions are codified separately for public schools and higher education.

What Physicians Cannot Do for Minors

Under R.C. 3129.02, a physician in Ohio cannot knowingly perform gender reassignment surgery on anyone under 18, and cannot prescribe cross-sex hormones or puberty-blocking drugs to help a minor with gender transition.¹ Counseling and therapy are not on this list. They carry their own rules, covered further down.

The statute defines each restricted category tightly. “Cross-sex hormone” means testosterone, estrogen, or progesterone given in amounts exceeding what a healthy person of the minor’s age and biological sex would naturally produce. “Puberty-blocking drugs” covers gonadotropin-releasing hormone analogs and synthetic drugs that suppress normal puberty. “Gender reassignment surgery” reaches both genital procedures such as vaginoplasty or phalloplasty and non-genital surgeries that alter characteristics typical of the minor’s biological sex.²

The regulated party throughout Chapter 3129 is the physician. The statute does not sweep in every category of healthcare provider by its terms.¹

Can Current Patients Continue Treatment?

Yes, but only under narrow conditions. R.C. 3129.02(B) allows a physician to keep prescribing cross-sex hormones or puberty blockers to a minor who was already receiving them before the law took effect. All three of the following must be true:

The minor has been a continuous Ohio resident since April 24, 2024.
The physician started the prescription course before that date.
The physician has determined and documented in the medical record that discontinuing the medication would cause harm to the minor.

The grandfather rule covers hormones and blockers only, not surgery. It protects a specific existing course of treatment, not new prescriptions started afterward.¹

Medical Care Still Allowed

R.C. 3129.04 carves out situations the Chapter 3129 prohibitions do not touch. Physicians may still treat a minor born with a medically verifiable disorder of sex development, including cases where external biological sex characteristics are irresolvably ambiguous, such as individuals with atypical chromosomal patterns or both ovarian and testicular tissue.³

The exceptions also reach minors diagnosed with a disorder of sexual development confirmed through genetic or biochemical testing showing abnormal sex chromosome structure or hormone production. And physicians can treat any infection, injury, disease, or disorder caused or worsened by prior gender transition services, whether or not those earlier services were performed legally.³ That last exception matters for a minor who received care out of state or before the ban and now needs follow-up for complications.

No Ohio Medicaid Coverage

R.C. 3129.06 pulls funding out of the picture. Ohio Medicaid cannot cover gender transition services for minors, even in scenarios where a physician might otherwise be permitted to act. Three exceptions preserve some coverage: treatment falling under the permissible medical exceptions in R.C. 3129.04, mental health services for a gender-related condition, and any services that do not meet the statute’s definition of gender transition services.⁴

Mental Health Screening and Consent Rules

R.C. 3129.03 governs mental health professionals treating a minor who presents with a gender-related condition. Before diagnosis or treatment, the provider must obtain consent from at least one parent, legal custodian, or guardian. The statute says “consent” without specifying a written form, but the requirement overrides general mental health consent rules that might otherwise let a minor seek certain care independently.⁵

The provider must also screen the minor throughout diagnosis and treatment for two categories of concerns:

Comorbidities such as depression, anxiety, ADHD, autism spectrum disorder, and other mental health conditions that may be influencing the gender-related condition.
Physical, sexual, mental, and emotional abuse and other traumas.

The screening is ongoing, not a one-time intake check. The statute uses the phrase “during the course of diagnosis and treatment,” meaning the provider keeps evaluating as care proceeds.⁵

How the Law Is Enforced

R.C. 3129.05 classifies any violation of the medical prohibitions, the mental health rules, or the Medicaid coverage restriction as unprofessional conduct. That classification lets the relevant professional licensing board investigate and impose discipline up to license suspension or revocation.⁶

The Ohio Attorney General has separate authority to bring an enforcement action to compel compliance with the medical or mental health provisions. Two tracks run in parallel: licensing boards discipline individual practitioners, and the AG’s office can pursue broader compliance actions.⁶

Chapter 3129 does not create a new private right for families to sue physicians over the medical prohibitions. The statute preserves any private cause of action that already exists under Ohio common law, but it adds no new statutory claim with specified damages or attorney’s fees on the medical side.⁶ The athletics side is different, as described below.

Sex-Separated Athletic Teams

The SAVE Act also enacted what the legislature titled the Save Women’s Sports Act, with parallel rules for K-12 schools and colleges. The K-12 provision, originally R.C. 3313.5319 and later recodified as R.C. 3313.5320, requires every school participating in interscholastic athletics to designate teams by biological sex: separate female teams, separate male teams, and co-ed teams where applicable. Schools and athletic organizations cannot allow male students to compete on teams or in competitions designated for female participants only.

R.C. 3345.562 mirrors that structure for colleges. Every state institution of higher education and every private college belonging to the NCAA, NAIA, or NJCAA must designate intercollegiate teams by sex, and male students cannot participate on women’s teams or in women’s competitions.⁷ Neither statute restricts any student’s eligibility for male or co-ed teams.

When a participant’s sex is disputed at the K-12 level, the statute requires a signed physician’s statement based on internal and external reproductive anatomy, natural testosterone levels, and genetic analysis. At the college level, biological sex is defined using the same criteria as R.C. 3129.01: sex chromosomes, naturally occurring hormones, gonads, and genitalia present at birth.²

Who Can Sue Over Athletics Violations

The college athletics statute creates an explicit private right of action. Under R.C. 3345.562(F), a participant deprived of an athletic opportunity or harmed by a violation can sue the institution for injunctive relief, damages, and other available remedies. The same right extends to students who face retaliation for reporting a violation, and to institutions penalized by accrediting bodies or athletic associations for maintaining sex-separated teams.⁷

A civil action under the athletics provision must be filed within two years of the violation. The statute also bars state agencies, political subdivisions, and athletic associations from taking adverse action against a school or college for complying with the sex-separation requirements.⁷

Federal Law Around the Edges

Section 1557 of the Affordable Care Act prohibits sex-based discrimination in federally funded health programs, and prior federal interpretations read gender identity into that protection. As of early 2026, the U.S. Department of Health and Human Services has proposed rules that would bar federal Medicaid funding for gender-affirming care, a departure from earlier guidance. How federal enforcement evolves will shape whether Ohio’s Medicaid prohibition draws a federal challenge or federal reinforcement.

Title IX prohibits sex discrimination in federally funded education programs. The federal definition of “sex” under Title IX has shifted between administrations, and the current regulatory posture does not explicitly extend gender identity protections in the athletics context. Ohio’s sex-separation rules for sports are unlikely to conflict with federal enforcement priorities as they stand in 2026.

Federal emergency treatment obligations under EMTALA still apply regardless of state law. A hospital participating in Medicare must screen and stabilize patients with emergency medical conditions, even where stabilizing treatment might otherwise fall inside a state restriction.

1
Ohio Legislative Service Commission. Ohio Code 3129.02 – Physician Prohibitions
2
Ohio Legislative Service Commission. Ohio Code 3129.01 – Definitions
3
Ohio Legislative Service Commission. Ohio Code 3129.04 – Permissible Medical Treatment
4
Ohio Legislative Service Commission. Ohio Code 3129.06 – Medicaid Coverage
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Ohio Legislative Service Commission. Ohio Code 3129.03 – Mental Health Care
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Ohio Legislative Service Commission. Ohio Code 3129.05 – Enforcement
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Ohio Legislative Service Commission. Ohio Code 3345.562 – Intercollegiate Athletics