Colorado Prohibit Surgeries for Treatment in Response to Minors' Perception of Sex or Gender Measure (2026)

Colorado Prohibit Surgeries for Treatment in Response to Minors' Perception of Sex or Gender Measure
Election date November 3, 2026
Topic Healthcare governance and LGBTQ issues
Status On the ballot
Type Initiated state statute	Origin Citizens

The Colorado Prohibit Surgeries for Treatment in Response to Minors' Perception of Sex or Gender Measure is on the ballot in Colorado as an initiated state statute on November 3, 2026.

A "yes" vote supports this ballot initiative to: prohibit healthcare professionals from performing or providing surgeries to persons under age 18 for the purpose of altering biological sex characteristics, defined as “treatment in response to a minor’s perception of sex or gender”; and prohibit the use of state or federal funds, Medicaid reimbursements, or insurance coverage to pay for such procedures.

A "no" vote opposes this ballot initiative to: prohibit healthcare professionals from performing or providing surgeries to individuals under age 18 for the purpose of altering biological sex characteristics, defined as “treatment in response to a minor’s perception of sex or gender”; and prohibit the use of state or federal funds, Medicaid reimbursements, or insurance coverage to pay for such procedures.

Overview

What would the ballot initiative change?

See also: Text of measure

The ballot initiative would prohibit healthcare professionals from performing or providing surgeries to anyone under age 18 for the purpose of changing the person’s sex characteristics based on their perception of sex or gender. The ballot initiative would also prohibit state and federal funds, such as Medicaid, or insurance coverage, from paying for these surgeries. These bans would not include "treatment for persons born with a medically verifiable disorder of sex development," "treatment for acquired physical or chemical abnormalities," and male circumcision.

As of 2026, medical procedures for transgender minors are legal in Colorado, and health insurance providers are prohibited from denying or limiting coverage for such procedures when a healthcare provider determines the treatment is medically necessary.

The terms used to describe the procedures referenced in this initiative differ between supporters and opponents.

• The ballot initiative describes these procedures as altering a child’s biological sex; the campaign, Protect Kids Colorado, called them irreversible sex change surgeries; and Secretary of Health and Human Services Robert F. Kennedy Jr. issued a declaration describing them as pediatric sex-rejecting procedures.
• Colorado defined these procedures in state law as gender-affirming healthcare designed to address gender dysphoria; the American Academy of Pediatrics described them as gender-affirmative surgical interventions; and the ACLU called them gender-affirming medical care.

Text of measure

Ballot title

The ballot title for the initiative is as follows:

“

Shall there be a change to the Colorado Revised Statutes modifying existing law by prohibiting surgery on a minor for the purpose of altering the minor’s biological sex characteristics, and, in connection therewith, prohibiting any health-care professional or other person from knowingly performing, prescribing, administering, or providing any surgery to a minor for the purpose of altering the minor’s biological sex characteristics and prohibiting the use of state or federal funds, Medicaid reimbursement, or insurance coverage to pay for this type of surgery?

”

Full text

The ballot initiative would add a new section to Colorado Revised Statutes 12-30, which governs healthcare professionals and occupations. The following underlined text would be added:

Note: Use your mouse to scroll over the text below to view the ballot language.

12-30-125. Prohibition on surgery for minors – prohibition on state funding for surgery - short title – definitions.

(1) Short title. The short title of this section is the “protect children from irreversible sex change surgery act”.

(2) Definitions. As used in this section, unless the context otherwise requires:

(a) “altering biological sex characteristics” means treatment in response to a minor’s perception of sex or gender. It does not include treatment for persons born with a medically verifiable disorder of sex development or treatment for acquired physical or chemical abnormalities. “Altering biological sex characteristics” does not include male circumcision.

(b) “health-care professional” means any person licensed in this state or any other state to practice medicine, chiropractic, nursing, physical therapy, podiatry, dentistry, pharmacy, optometry, psychiatry, psychology, mental health therapy, or other healing arts. The term includes any professional corporation or other professional entity comprised of such health-care providers as permitted by the laws of this state.

(c) “minor” means an individual who is under eighteen years of age.

(3) Prohibition on medical interventions on minors. A health-care professional or other person shall not knowingly perform, prescribe, administer, or provide any surgery to a minor for the purpose of altering biological sex characteristics.

(4) No state or federal funds, Medicaid reimbursements, or insurance coverage may be used to pay for any prohibited medical interventions described in subsection (3) of this section.

(5) Severability. If any section of this section is found unconstitutional or invalid, the remaining sections shall remain in effect.

Support

Protect Kids Colorado is leading the campaign in support of the ballot initiative, along with two others—Initiative 108 and Initiative 109. Supporters named the initiative the Protect Children from Irreversible Sex Change Surgery Act.

Supporters

Former Officials

• State Sen. Kevin Lundberg (R)

Organizations

• Colorado Catholic Conference
• Focus on the Family

Arguments

• Focus on the Family: "Children should be safeguarded from making irreversible decisions about their reproductive future. This citizen initiative prohibits irreversible sex-change surgeries for anyone under the age of 18."
• Protect Kids Colorado: "It's irreversible. It's robbing a child of a reproductive future. It needs to wait. Our ballot measure prohibits irreversible sex change surgeries on minor children, age 17 and younger. We set age limits on many things in Colorado — from voting, to drinking, to signing a contract. It's too early."
• Colorado Catholic Conference: "The fundamental order of the human person is the unity of body and soul and attempts to alter biological sex are contrary to God's divine plan for that person. This is why the Church emphasizes the need to respect the natural order of the human person, especially of children whose physical and mental well-being will be seriously harmed by permanent and life-altering medical interventions and surgeries."

Opposition

Families Not Politics is leading the campaign in opposition to the ballot initiative, along with Initiative 109.

Opponents

Organizations

• Inside Out Youth Services
• Interfaith Alliance
• One Colorado
• Planned Parenthood of the Rocky Mountains
• Rocky Mountain Equality

Arguments

• Rocky Mountain Equality: "This initiative would limit access to gender-affirming healthcare for transgender youth, even after extensive evaluation and with parental support."
• Nadine Bridges, executive director of One Colorado: "These proposals go too far. They push the government into personal health care decisions that should stay with families and medical providers. That kind of political intrusion does not make families safer or stronger."

Campaign finance

See also: Ballot measure campaign finance, 2026 and Contributions to Colorado ballot measure campaigns

Protect Kids Colorado registered as a political action committee (PAC) to support the ballot initiative. Families Not Politics registered as a PAC to oppose the ballot initiative.

	Cash Contributions	In-Kind Contributions	Total Contributions	Cash Expenditures	Total Expenditures
Support	$53,396.81	$2,333.09	$55,729.90	$51,881.91	$54,215.00
Oppose	$0.00	$0.00	$0.00	$0.00	$0.00
Total	$53,396.81	$2,333.09	$55,729.90	$51,881.91	$54,215.00

Support

The following table includes contribution and expenditure totals for the committee in support of the ballot measure.

Committees in support of Prohibit Surgeries for Treatment in Response to Minors' Perception of Sex or Gender Measure
Committee	Cash Contributions	In-Kind Contributions	Total Contributions	Cash Expenditures	Total Expenditures
Protect Kids Colorado	$53,396.81	$2,333.09	$55,729.90	$51,881.91	$54,215.00
Total	$53,396.81	$2,333.09	$55,729.90	$51,881.91	$54,215.00

Donors

The following were the top donors to the committees.

Donor	Cash Contributions	In-Kind Contributions	Total Contributions
Protect Kids Colorado, 501(c)4	$29,731.39	$2,031.70	$31,763.09
Pikes Peak Citizens For Life	$4,000.00	$0.00	$4,000.00

Opposition

The following table includes contribution and expenditure totals for the committee in support of the ballot measure.

Committees in support of Prohibit Surgeries for Treatment in Response to Minors' Perception of Sex or Gender Measure
Committee	Cash Contributions	In-Kind Contributions	Total Contributions	Cash Expenditures	Total Expenditures
Families Not Politics	$0.00	$0.00	$0.00	$0.00	$0.00
Total	$0.00	$0.00	$0.00	$0.00	$0.00

Background

Bans on surgical procedures for transgender minors

As of March 2026, 27 states had passed laws prohibiting surgical procedures for transgender minors.

The first state to ban these procedures was Arkansas in 2021. Two additional states enacted bans in 2022, 19 states in 2023, four states in 2024, and one state in 2025. Republicans held trifectas in 23 of the 27 states at the time of enactment. The other four states—Kentucky, Louisiana, North Carolina, and Kansas—had divided governments, where Democratic governors vetoed the bills, and Republican-controlled legislatures overrode those vetoes.

Federal regulations on surgical procedures for transgender minors

On January 28, 2025, President Donald Trump (R) issued Executive Order 14187, which directed federal agencies to restrict or eliminate federal support, funding, and insurance coverage for pediatric medical procedures to "delay the onset or progression of normally timed puberty in an individual who does not identify as his or her sex;" "align an individual’s physical appearance with an identity that differs from his or her sex;" and "attempt to transform an individual’s physical appearance to align with an identity that differs from his or her sex or that attempt to alter or remove an individual’s sexual organs to minimize or destroy their natural biological functions."

On December 18, 2025, the U.S. Department of Health and Human Services issued a statement saying the Centers for Medicare & Medicaid Services would " bar hospitals from performing sex-rejecting procedures on children under age 18 as a condition of participation in Medicare and Medicaid programs." Secretary Robert F. Kennedy Jr. said, "Under my leadership, and answering President Trump’s call to action, the federal government will do everything in its power to stop unsafe, irreversible practices that put our children at risk."

On December 23, 2025, New York Attorney General Letitia James (D) announced that New York and 18 other states and D.C. filed litigation against Secretary Kennedy. Attorney General James said, "Secretary Kennedy cannot unilaterally change medical standards by posting a document online, and no one should lose access to medically necessary health care because their federal government tried to interfere in decisions that belong in doctors’ offices."

On March 19, 2026, U.S. District Court Judge Mustafa Kasubhai ruled against Kennedy from the bench, with a written decision expected at a later date.

Other ballot measures

Missouri Amendment 3 (2026)

See also: Missouri Amendment 3, Prohibit Abortion and Gender Transition Procedures for Minors Amendment (2026)

Voters in Missouri will decide Amendment 3 on November 3, 2026. Amendment 3 would amend the Missouri Constitution to prohibit gender transition surgeries for minors, defined as surgical procedures"performed for the purpose of assisting an individual with identifying with and living as a gender different from his or her biological sex." As of 2026, state statute prohibited such procedures in Missouri.

Amendment 3 would also repeal the Right to Reproductive Freedom Initiative (2024), which voters approved in 2024, and prohibit abortion, with exceptions.

The Missouri General Assembly referred the constitutional amendment to the ballot, with support from 98% of legislative Republicans and none of the Democrats, excluding absent or otherwise not voting members.

Path to the ballot

See also: Laws governing the initiative process in Colorado

The state process

An initiated state statute is a citizen-initiated ballot measure that amends state statute. There are 21 states that allow citizens to initiate state statutes, including 14 that provide for direct initiatives and nine (9) that provide for indirect initiatives (two provide for both). An indirect initiated state statute goes to the legislature after a successful signature drive. The legislatures in these states have the option of approving the initiative itself, rather than the initiative appearing on the ballot.

In Colorado, the number of signatures required for an initiated state statute is equal to 5% of the votes cast for the Colorado secretary of state in the preceding general election. A simple majority vote is required for voter approval. The requirements to get an initiated state statute certified for the 2026 ballot:

• Signatures: 124,238 valid signatures are required.
• Deadline: The deadline to submit signatures is August 3, 2026.

Stages of this ballot initiative

The following is the timeline of the initiative:

• July 25, 2025: Erin Lee and Michele Austin filed the ballot initiative.
• August 25, 2025: The initiative petition format was approved, allowing signature gathering to begin, with signatures due on February 20, 2026.
• January 12, 2026: Supporters reported that 75% of the required signature threshold had been met.
• February 20, 2026: The campaign supporting the initiative, Protect Kids Colorado, submitted 164,922 signatures to the Elections Division of the Colorado Secretary of State’s Office.
• March 17, 2026: Secretary of State Jena Griswold (D) announced that a 5% random sample of submitted signatures indicated the petition contained more than 110% of the required valid signatures, qualifying the initiative for the ballot.

How to cast a vote

See also: Voting in Colorado

See below to learn more about current voter registration rules, identification requirements, and poll times in Colorado.

How to vote in Colorado

Poll times

In Colorado, polls are open from 7:00 a.m. to 7:00 p.m. local time for those who choose to vote in person rather than by mail. An individual who is in line at the time polls close must be allowed to vote.

Registration

Check your voter registration status here.

In Colorado, an individual can pre-register to vote if they are at least 15 years old. Voters must be at least 18 years old to vote in any election. A voter must be a citizen of the United States and have established residence in Colorado to vote.

Colorado voters can register to vote through Election Day. However, in order to automatically receive a absentee/mail-in ballot, a voter must register online, through the mail, at a voter registration agency, or at a driver's license examination facility at least eight days prior to Election Day. A voter that registers through a voter registration drive must submit their application no later than 22 days before the election to automatically receive an absentee/mail-in ballot. A voter can register online or submit a form in person or by fax, email, or mail.

Automatic registration

See also: Automatic voter registration

Colorado automatically registers eligible individuals to vote through the Department of Motor Vehicles and certain other state agencies.

Online registration

See also: Online voter registration

Colorado has implemented an online voter registration system. Residents can register to vote by visiting this website.

Same-day registration

See also: Same-day voter registration

Colorado allows same-day voter registration for individuals who vote in person.

Residency requirements

Colorado law requires 22 days of residency in the state before a person may vote.

Verification of citizenship

See also: Laws permitting noncitizens to vote in the United States

Colorado does not require proof of citizenship for voter registration. An individual applying to register to vote must attest that they are a U.S. citizen under penalty of perjury.

All 49 states with voter registration systems require applicants to declare that they are U.S. citizens in order to register to vote in state and federal elections, under penalty of perjury or other punishment. Eight states — Alabama, Arizona, Kansas, Louisiana, New Hampshire, South Dakota, Utah, and Wyoming — have laws requiring individuals provide proof of citizenship at the time of voter registration, whether in effect or not. Three states, Florida, Georgia and Mississippi, require a person provide proof of citizenship if their citizenship status cannot be verified by other means. One state, Ohio, requires proof of citizenship only when registering to vote at a Bureau of Motor Vehicles facility. In three states — California, Maryland, and Vermont — at least one local jurisdiction allows noncitizens to vote in some local elections. Noncitizens registering to vote in those elections must complete a voter registration application provided by the local jurisdiction and are not eligible to register as state or federal voters.

Verifying your registration

The site Go Vote Colorado, run by the Colorado Secretary of State office, allows residents to check their voter registration status online.

Voter ID requirements

Colorado requires voters to present non-photo identification when voting in person. If voting by mail for the first, a voter may also need to return a photocopy of his or her identification with their mail-in ballot. Click here for more information.

The following list of accepted forms of identification was current as of October 2025. Click here for the most current information, sourced directly from the Office of the Colorado Secretary of State.

“

The following documents are acceptable forms of identification: A valid Colorado driver’s license or valid identification card issued by the Colorado Department of Revenue. (Note: documents issued to not lawfully present and temporarily lawfully present individuals under Part 5 of Article 2 of Title 42, C.R.S. are not acceptable forms of identification.) A valid U.S. passport. A valid employee identification card with a photograph of the eligible elector issued by any branch, department, agency, or entity of the U.S. government or of Colorado, or by any county, municipality, board, authority, or other political subdivision of Colorado. A valid pilot’s license issued by the federal aviation administration or other authorized agency of the U.S. A valid U.S. military identification card with a photograph of the eligible elector. A copy of a current (within the last 60 days) utility bill, bank statement, government check, paycheck, or other government document that shows the name and address of the elector. A Certificate of Degree of Indian or Alaskan Native Blood. A valid Medicare or Medicaid card issued by the Centers for Medicare and Medicaid Services. A certified copy of a U.S. birth certificate for the elector. Certified documentation of naturalization. A valid student identification card with a photograph of the eligible elector issued by an institute of higher education in Colorado, as defined in section 23-3.1-102(5), C.R.S.. A valid veteran identification card issued by the U.S. department of veterans affairs veterans health administration with a photograph of the eligible elector. A valid identification card issued by a federally recognized tribal government certifying tribal membership. Any form of identification listed above that shows your address must show a Colorado address to qualify as an acceptable form of identification. The following documents are also considered acceptable forms of identification for voting: Verification that a voter is a resident of a group residential facility, as defined in section 1-1-104(18.5), C.R.S. Verification that a voter is a person committed to the department of human services and confined and eligible to register and vote shall be considered sufficient identification of such person for the purposes of section 1-2-210.5, C.R.S. Written correspondence from the county sheriff or his or her designee to the county clerk indicating that a voter is confined in a county jail or detention facility.

”

• Note: SB 1, signed into law on May 12, 2025, specified that tribal IDs issued by the Bureau of Indian Affairs, the Indian Health Service, or another federal agency were also valid identification.

See also

2026 ballot measures

View other measures certified for the 2026 ballot across the U.S. and in Colorado.

• 2026 ballot measures
• Colorado 2026 ballot measures
• Colorado elections, 2026

Colorado ballot measures

Explore Colorado's ballot measure history, including citizen-initiated ballot measures.

• List of Colorado ballot measures
• Healthcare governance ballot measures
• Colorado State Legislature

Initiative process

Understand how measures are placed on the ballot and the rules that apply.

• Laws governing the initiative process in Colorado
• Initiated state statute
• Colorado Constitution

External links

• Colorado Initiative #110 (2026)

Footnotes

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