2026 Colorado Proposition 135 is a proposed ballot measure that will appear before voters in Colorado during the 2026 general election. The measure would prohibit gender-affirming surgery for minors in the state, and would ban the use of state or federal funds, insurance coverage, or Medicaid reimbursements to pay for gender-affirming surgery.
Background Currently, gender-affirming surgery is legal for minors in the state of Colorado, and health insurance providers are not permitted to deny or limit insurance coverage for gender-affirming surgery if a provider determines the treatment is "medically necessary". As of August 2026, gender-affirming surgery for minors is banned by law in 25 U.S. states.
Studies reviewing insurance data have found that gender-affirming surgeries are never performed on prepubescent children and are very rarely performed on adolescents. When surgeries are offered as an option to adolescents, it is only done with parental consent and "after years of therapy and consultation with the family" as well as several medical experts and also only offered in "extreme cases" of gender dysphoria. For trans teens ages 15-17, the rate of gender-affirming surgeries was 2.1 per 100,000 transgender individuals with the vast majority being breast reductions as opposed to genital surgeries.
As of 2026, Colorado's major children's hospitals already do not offer gender-affirming surgeries to trans youth. Children's Hospital Colorado and UC Health have never offered surgeries despite offering other kinds of gender-affirming care to minors, and Denver Health stopped offering surgeries, along with all other kinds of gender-affirming care, to minors in early 2025 following "escalating actions" from the Trump administration targeting the care.
A 2024 Harvard study found that cisgender minors received the surgeries that transgender minors receive for gender-affirming purposes at much higher rates than transgender minors, with 97% of breast reduction procedures performed on minors being for cisgender teenagers.
Proposition 135 would enact the Protect Children from Irreversible Sex Change Surgery Act, prohibiting gender-affirming surgery for Colorado residents under the age of 18. The measure would also prohibit minors from using state and federal funds (including insurance coverage or Medicaid reimbursements) to pay for gender-affirming surgery. The measure would not prohibit "treatment for acquired physical or chemical abnormalities", "treatment for persons born with a medically verifiable disorder of sex development", or male circumcision.
On March 17, 2026, the Colorado secretary of state announced that Proposition 135 had qualified for the November ballot after submitting nearly 165,000 petition signatures.
Opponents have expressed concern that the measure would interfere with doctors and parents decisions to make medical decisions for their children and also that the measure's wording is written vaguely enough that it could restrict healthcare for people who are not trans.
In September 2026, the Positive Women's Network, filed a campaign finance complaint with the Colorado Secretary of State against proponents of the ballot measure for allegedly "failing to report payments to a petition circulation company as required by state law."
Contents The proposition will appear on the ballot as follows:
Campaigns Support
Opposition
See also
2026 Washington Initiative 638
Notes
References