There are eroding forces at work in our nation. They could be called Christian Nationalism, white nationalism, the Dark Enlightenment/neo-reactionaries, amongst others. But what unites these movements is the thought that the vulnerable—like the trans community and immigrants—should be left to fend for themselves, or eradicated altogether. But just like in moments of crisis in decades prior, mutual aid springs up to fill the gaps left behind by the government. People have risen to the occasion to monitor the activity of ICE, or to guard their communities against neo-Nazi weirdos who goose step through Black neighborhoods. In Louisiana, the trans community has found friends in the Trans Income Project (TIP). Beginning as a mutual aid group that provided cash and food directly to the trans community, as well as other programs like peer groups, they have since expanded their community offerings even more. After the state quietly banned trans adults from using Medicaid to get hormone replacement therapy (HRT)—a vital part of trans health care—TIP is stepping in to pay for those who now can’t afford their HRT through a partnership with CrescentCare, with HRT provided through CrescentCare’s pharmacy. I sat down with the Trans Income Project’s executive director, Natalie Rupp, to learn more about TIP as well as their new initiative to get low income, Medicaid-enrolled trans adults the treatment they need.
Before we get to talking about the new initiative with CrescentCare, I would really like to know about the origins of the Trans Income Project and take it from there.
Trans Income Project initially started as an informal mutual aid-ish type program… I say “mutual aid-ish” only because it was not community funded, it was personally funded. I was working [in] philanthropy so I made more money than I needed, so I gave money away. But then my idea was, “What if we gave other people’s money away?” We could do a lot more that way and so I applied for the 501(c)(3) [nonprofit status], and then in January [2024] we officially launched.
We’ve been able to give out over $60,000 in cash. We’ve hosted twice-monthly support groups which are now down to once monthly, but still really exciting. We have a meal program where we have community members—cooks, and other folks in the community—deliver [over 1,000] hot meals for free… it’s really blossoming.
Beyond that, we have done some policy work. In the spring we got a bill passed unanimously through the New Orleans City Council. And that bill was one that I drafted with one of our board members, Corinne Green, and Lauren Hall from Below Sea Level Aid, and that was an immunity bill for sex workers who were reporting crimes. Up until recently, we’ve heard stories from folks about how they would never call a cop if something happened… it [also] allows for safety within the hospital systems. Since last November we and a cohort of other folks have been tracking the expected changes in attacks on Medicaid or transcare in general through the state legislature. They ended up doing a more roundabout thing and [changed] it through Medicaid specifically, which impacts low-income trans people only, and that’s really something that we can’t abide. The idea that low income folk are gonna be the ones that get hit first is something that we must stand against. Like, I’m on Medicaid… a lot of trans folk are on Medicaid. So we’ve built this partnership with CrescentCare as a way of combating what is clearly an attack on the trans community, as well as a specifically targeted one on low income folk.
Natalie Rupp
Photo: Katie Sikora
I guess you can call this a backdoor ban. Is this Medicaid ban only in Louisiana?
There have been some attempts nationwide in the “Big Beautiful Bill…” In the [original bill] that the House passed it did have a provision in it that would have made a national [Medicaid ban on trans care]. Luckily enough that didn’t happen… there are states in the South—Texas has had some issues—where [there] is the methodology of stripping trans folks of access to hormones. [Trans Income Project] is the first to build a systemic program like this that will then step in and replace the funding that the state is no longer willing to provide.
With abortion, most people know that if you ban abortion, people are still going to get abortions. So if I’m a trans person who wants to get gender affirming care, are there other workarounds?
Trans people have existed in this country for a very long time, if not forever, right? And we have always found ways of transitioning before it was accessible. Before there were gender clinics in the country, people would buy hormones off the gray market. And self-administered [hormones]—I’m not advocating for that, given the fact that trans bodies are often the site of medical experimentation… We are the site of a great deal of medical intervention from other folk that we didn’t even ask for necessarily, or our bodies are medicalized in ways by other people that we don’t agree to. And so to me, having access to CrescentCare specifically is a really valuable resource so that we can get our blood tested, we can see our [hormone] levels, we can make sure that everything is going well and get our regular doctor checkups along the way. Hormones and HRT [are] a basic part of a medical visit for a trans person. So the government stepping in and saying that we’re not gonna cover [HRT] is a huge thing… it is [a part] of our everyday life and it is very routine. It clearly is a statement from the government saying that they don’t want us to exist here and the thing is we always have and we always will. [A] lot of people seek care in other states… but our hope is that, particularly for the people in Louisiana, this program will prevent that necessity because CrescentCare does a great deal of tele-visits. The pharmacy delivers, and so it’s not even something where you have to be in the city. So our hope is that this program will help reach trans folks, who have already had a hard time accessing care, find broader and easier access to the care that they deserve.
What’s the day-to-day like in terms of trans health care? Is hormone therapy a daily thing, for example?
It depends on what your hormone regimen is. There are pills that you can take daily. There are weekly shots. There are gels, so it really depends on what your transition goals are, because not everyone has the same idea of what it means for their body to be trans or to realize their full body.
So hormone therapy is something that has to be done frequently. That’s not something that can just be stopped.
No, no. So stopping it is really not great… I remember when I started taking estrogen, my mood changed… hormones do affect the way we interact with the world on several levels. Additionally, our bodies will start to de-transition in certain ways, which is also one of the biggest problems with incarcerating trans folk. [In prison] they are often required to be forcibly detransitioned, meaning they’re not provided with the care they need, so their bodies will be changing in front of their eyes, which in my mind is torture. I can’t imagine being held in prison—which for me, I’d be in a men’s prison, which is also not great—and then my body would start to change in front of me in ways that would be horrific… You know, we’ve heard from folks who went to their pharmacies to pick up their meds and all of a sudden it was $100-plus. If you’re a low income person you’re like, “Wait what? I don’t have $100 right now.” Or even if you’re not a low income person and you’re just making ends meet, that can be a big expense that you didn’t expect, and then what? You’re gonna go without your hormones or you’re gonna have to go without something else. That tradeoff is not something that I’m comfortable with at all. This is a basic right for our existence. We shouldn’t have to decide whether or not I’m going to pay the phone bill, electric bill, buy some extra food this month, or get my hormones.
How did y’all find out that the state was no longer reimbursing hormone replacement therapy?
A lot of it was community feedback… some of it was looking into public records. Luckily, many people are still able to find access, and there still are ways to get care. The best way to get access right now is just to talk to your doctor, talk to your pharmacy, see what can be done.
Y’all are a pretty young organization. As the rise in anti-trans legislation has happened, has that changed your mission?
I think that our mission hasn’t particularly changed over time. I think our capacity to do more has changed. We started out as a staff of me, and then we have director of programs and operations Tobi Jaunzemis… they stepped in and they’re helping with a lot of stuff. They run the food program, they’re stepping in to run the cash program. Now we’ve got someone who helps write grants, and so there [are] a lot more people here and we have volunteers that work with us now, and so we have expanded what we can do. Which to me doesn’t suggest that we’ve been drifting away from our mission, because our mission is to ensure that the basic needs of trans folk are being met. We have just been expanding what options we are providing to make sure that those needs are met.
It started out just as cash, and then we were able to get food [assistance] built in, and support groups, and now we’re getting health care built in… The more funding we receive, the more volunteers we get, the more we can do for the community… We don’t generally do policy work—you know, you won’t see us at the Capitol really all that much unless people are asking us to join a coalition. The bill we passed here in the city was something that had been brought to my attention by members of the community, and so we worked to help advocate and make that happen. It wasn’t necessarily just like… pulling some issue out of the hat. It was like, “Oh these are the concerns we’ve heard, we should probably do something about that.” We try to ensure that all of our programming is tied to community need—when the community says, “Hey, this is going on. This is a problem we’re seeing.” [For example], rising costs of rent are a big issue right now, and we’ve been talking with folks about ways in which we can help support rent funds and support people staying in their homes… We’re always looking for ways in which we can support the community in the challenges we face.
So just more along the lines of holistic mutual aid for the community and not necessarily one specific avenue.
Yeah, it’s really about a holistic approach to what it means to support trans folk because we’re not just economic beings, we’re not just health care beings, we’re not just housing beings… We interact with the world the same way that everyone else does. The things that we need and the things that we can be supported with are the same as everyone else’s, except in one case [HRT].
So for the partnership y’all have with CrescentCare, do you have any hopes? What’s your end goal with this partnership?
The [partnership] with CrescentCare arose because they were aware of the changes [to Louisiana Medicaid] and we approached them with the idea of being a third-party payer—so we’re going to step in where Medicaid is no longer paying—and they were really happy to work with us on that. For right now the program is limited to Medicaid-qualifying adults and our hope is that we can expand this program as more folks lose access. Our hope is to—as more people get kicked off of their care or lose access to coverage for hormones—be able to meet that need. Of course that does mean we do need to have people continuing to donate to our program with CrescentCare. We’re trying to ensure we’ll always have enough money to make sure that when more people lose access, we’re ready to meet them where they are. And so we’re really excited about this program and our hope is that it can continue to support the community for as long as we need, as long as this specific challenge is one that we’re facing.
Do you have any concerns that the state may try to interfere at all?
I really hope not. That’s my answer. I hope they don’t. If the government is concerned [and] they don’t want to pay for this—you know, medical care anymore—we’re doing it. I’d rather if they did [pay], I believe that it is a right and a basic medical care support system that they should be stepping up and doing, but the fact is that trans people have always helped take care of themselves and have always supported each other in our transitions. And so this doesn’t really change that, it just changes who’s paying for some stuff.
Outside of the sex worker protections bill that was passed in May, are there any other victories or wins or anything that has happened that’s giving you some optimism or hope?
I think that honestly the launch of this program is something that gives me a lot of hope because it’s a formal partnership with a really valuable large institution in our community. So to me it really does show that when we work together we can help create the systems that we need. To me it’s saying that while there are folks who don’t care about the trans community or there are folks who are actively antagonistic towards the trans community, that’s not what most people feel… We can work with like-minded community members, with people who understand the basic health care components of what we’re talking about, and we can work together to build this. We’re all in this together. That’s what’s giving me a lot of hope… looking to the future. I am scared… I’m concerned about a lot of things. I’ve heard a lot of the bills that states have tried to pass or the way people talk about trans folk—particularly at the national level—scares me, but I also know that we are a strong, capable community, and I know that no matter what happens, we will be there for each other.
For more info, check out transincomeproject.org and @trans_income_project.
Illustrations by Jam Dyer
