If I'm a Texas-licensed psychologist, counselor, social worker, or marriage and family therapist, am I covered by SB 14's restrictions on gender-transition care for minors, even though I can't perform surgeries or write prescriptions?

Plain-English summary

The Texas Behavioral Health Executive Council asked whether psychologists, licensed professional counselors, marriage and family therapists, and social workers count as "health care providers" under the Texas law enacted by Senate Bill 14. The Council noted that its licensees cannot perform the surgeries or prescribe the drugs listed in Health and Safety Code section 161.702.

The AG answered that the definition in section 161.701(2) includes these licensed mental health professionals. Their lack of authority to perform the listed procedures does not remove them from the defined class. The statute also bars public money from being used, granted, paid, or distributed to a health care provider who "provides or facilitates" a prohibited procedure or treatment for a child. The AG read "facilitate" to mean "to make easier" or "to help bring about" and described mental health assessments and recommendations as a possible starting point for the prohibited interventions.

The opinion separately discusses professional discipline under existing licensing statutes and rules. It cites an earlier AG opinion stating that a person facilitating the prohibited procedures "could be engaged in child abuse," the reporting duty for professionals with reasonable cause to believe a child has been or may be abused, and the potential licensing consequences of a criminal conviction. Its summary says a licensee facilitating an unlawful procedure is barred from receiving public money for that effort and risks license revocation.

What the opinion means for you

Licensed mental health professionals

The AG includes your profession in the statute's definition of a health care provider, even though surgery and prescribing are outside your practice. The opinion does not draw a safe-harbor line for clinical conversations, supportive psychotherapy, or general assessments. It identifies assessments and recommendations that initiate a prohibited intervention as relevant to facilitation. Evaluate the purpose and role of particular work under the statute and applicable licensing rules before treating it as outside the opinion's analysis.

Behavioral Health Executive Council

The opinion treats existing profession-specific licensing standards as a separate source of possible discipline. It does not say that the physician-license revocation provision itself applies to the Council's licensees. The AG also points to the reporting duty in Family Code section 261.101(b) for licensed professionals who, in the course of their duties, have direct contact with children and reasonable cause to believe abuse has occurred or may occur.

Public funders and providers

The public-money provision addresses money used, granted, paid, or distributed directly or indirectly to a provider or other entity that provides or facilitates a prohibited procedure or treatment. The AG concluded that a mental health licensee who helps bring about such a procedure cannot lawfully receive public funding for that venture. The opinion does not decide whether any identified individual assessment or recommendation meets that test.

Common questions

Q: Are Texas counselors and social workers "health care providers" under this law?
A: Yes. The AG read section 161.701(2) to include the mental health professions regulated by the Behavioral Health Executive Council. The definition does not require the provider to hold a prescription pad or perform surgery.

Q: What did the AG say about facilitation?
A: The opinion uses the ordinary meaning, "to make easier" or "to help bring about." It describes mental health assessments and recommendations as possible steps that initiate the procedures or treatments prohibited by section 161.702.

Q: Did the opinion exempt general assessment or supportive therapy?
A: No such exemption appears in the opinion. It does not decide the status of every clinical conversation, and its discussion of assessments gives no blanket assurance that an assessment falls outside facilitation.

Q: Does the physician-license provision automatically revoke a counselor's license?
A: The opinion discusses the physician-license provision separately. For Council licensees, it identifies existing professional standards, possible discipline, and licensing consequences if a professional is criminally convicted.

Q: Does the opinion decide whether a particular clinician's work was unlawful?
A: No individual clinician's work was before the AG. The opinion answers whether Council licensees fall within the statutory definition and explains potential consequences of facilitating a prohibited procedure or treatment.

Background and statutory framework

Health and Safety Code section 161.702 lists procedures and treatments that physicians and health care providers may not knowingly provide to a child for the purposes specified in the statute. Section 161.701(2) defines "health care provider" as a person other than a physician who is licensed, certified, or otherwise authorized by Texas law to provide or render health care or dispense or prescribe a drug in ordinary practice. The AG concluded mental health care fits that definition. It cites State v. Loe for the Texas Supreme Court's decision upholding the statute's constitutionality.

The public-money provision adds the restriction for an entity or person providing or facilitating a prohibited procedure or treatment. The opinion reads that provision to reach mental health professionals whose assessments or recommendations help bring about the intervention. It also discusses the Council's existing disciplinary authority and Family Code reporting duties.

Citations and references

• Tex. Health & Safety Code §§ 161.701–.706 — definitions, listed procedures, public-money restriction, and enforcement
• Tex. Fam. Code § 261.101 — reporting by professionals
• Tex. Occ. Code § 53.021 — licensing consequences of criminal conviction
• State v. Loe, 692 S.W.3d 215 (Tex. 2024) — constitutionality of the statute

Source

• Original PDF: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/2026/kp-0518.pdf

Original opinion text

February 27, 2026

Mr. Darrel D. Spinks
Executive Director
Texas Behavioral Health Executive Council
1801 Congress Avenue, Suite 7.300
Austin, Texas 78701

Opinion No. KP-0518
Re: Interpretation of "health care provider" under Tex. Health & Safety Code § 161.701(2) and associated issues (RQ-0605-KP)

Dear Mr. Spinks:

You seek clarification regarding the application of S.B. 14 to "mental health care providers" licensed by the Texas Behavioral Health Executive Council. First, you ask whether the definition of "health care provider," which was codified in subsection 161.701(2) of the Health and Safety Code, encompasses the Council's licensees. If so, you also ask "how" the licensees "are impacted by S.B. 14" in relation to "mental health care services not specifically enumerated." We answer both questions in turn.

The Legislature codified various restrictions on health care providers as well as physicians involved with procedures and treatments afforded to children for gender transitioning, gender reassignment, and gender dysphoria.

The legislation at the heart of your request relates to procedures and treatments afforded to certain children for gender transitioning, gender reassignment, and gender dysphoria. See Act of May 17, 2023, 88th Leg., R.S., ch. 335, 2023 Tex. Gen. Laws 732, 732–36 (current version at Tex. Health & Safety Code §§ 62.151(g), 161.701–.706; Tex. Occ. Code §§ 164.052(a)(24), .0552; Tex. Hum. Res. Code § 32.024(rr)). See generally State v. Loe, 692 S.W.3d 215, 239 (Tex. 2024) (upholding the statute's constitutionality). It codified what is now subchapter Y in Chapter 161 of the Health and Safety Code, which prohibits the provision of certain procedures and treatments "[f]or the purpose of transitioning a child's biological sex as determined by the sex organs, chromosomes, and endogenous profiles of the child or affirming the child's perception of the child's sex if that perception is inconsistent with the child's biological sex." Tex. Health & Safety Code § 161.702. Both "physician[s]" and "health care provider[s]" are thus prohibited from "knowingly" "perform[ing] a surgery that sterilizes the child," "perform[ing] a mastectomy," or "remov[ing] any otherwise healthy or non-diseased body part or tissue." Id. § 161.702(1)–(2), (4). Neither may these individuals "knowingly[] . . . provide, prescribe, administer, or dispense . . . prescription drugs that induce transient or permanent infertility" in children — specifically, "puberty suppression or blocking prescription drugs to stop or delay normal puberty;" "supraphysiologic doses of testosterone to females;" and "supraphysiologic doses of estrogen to males." Id. § 161.702(3)(A)–(C). Ultimately, the Attorney General has enforcement authority over ongoing, completed, or threatened violations of these constraints. Id. § 161.706(a).

The subchapter also imposes other restrictions related to these prohibited procedures and treatments. For one, it forbids "[p]ublic money" being "directly or indirectly . . . used, granted, paid, or distributed to any health care provider, medical school, hospital, physician, or any other entity, organization, or individual that provides or facilitates the provision of a procedure or treatment to a child that is prohibited under [s]ection 161.702." Id. § 161.704. The subchapter also prohibits reimbursements from Medicaid and the child health plan program to health care providers and physicians who provide one of the prohibited procedures or treatments to a child. Id. § 161.705; see also id. § 62.151(g); Tex. Hum. Res. Code § 32.024(rr).

The Council's licensees plainly constitute health care providers under subsection 161.701(2), resulting in a bar on all public funds for those who facilitate prohibited procedures — in addition to the longstanding constraints on licensed practice.

Subsection 161.701(2) broadly defines a "[h]ealth care provider" as "a person other than a physician who is licensed, certified, or otherwise authorized by this state's laws to provide or render health care or to dispense or prescribe a prescription drug in the ordinary course of business or practice of a profession." Tex. Health & Safety Code § 161.701(2); see also id. § 161.701(4) (defining "[p]hysician"). The phrase "health care" is commonly understood to mean "efforts made to maintain or restore health . . . by trained and licensed professionals." Merriam-Webster's Collegiate Dictionary 574 (11th ed. 2020). The attributive noun "health" ordinarily refers to "physical and mental well-being." This makes clear that a health care provider engages in licensed efforts to maintain or restore health, whether in body or mind, and belies any perceived ambiguity in subsection 161.701(2).

Nor can there be any question that the Council's licensees — whom you refer to as "mental health care providers" — deal in health care. The framework governing "Health Professions" includes an entire subtitle for "Psychology and Counseling," which individually regulates the services of "Psychologists," "Marriage and Family Therapists," "Licensed Professional Counselors," as well as "Social Workers." See Tex. Occ. Code tit. 3, subtit. I, chs. 501–503, 505. These professions are unified in offering both "assessment" and "treatment" or "remediation" of various behavioral disorders. Many of these individuals are elsewhere defined as "[h]ealth care professional[s]," id. § 108.051(1)(L)–(M), and held to be "health care provider[s]" under the Texas Medical Liability Act. Fudge v. Wall, 308 S.W.3d 458, 462 (Tex. App.—Dallas 2010, no pet.); accord Mike Norgaard, LPC v. Pingel, 296 S.W.3d 284, 288 (Tex. App.—Fort Worth 2009, no pet.).

You nonetheless suggest that "mental health care providers are not intended to be encompassed within the scope of S.B. 14" because the prohibited procedures and treatments fall "outside [your licensees'] scope of practice." We disagree. The unambiguous definition of "health care provider" does not require a prescription pad or scalpel, and the Council conflates one form of unlawful conduct with a condition of membership in the entire class of health care providers. Critically, S.B. 14 codified more than a prohibition on providing certain surgeries and prescriptions; it also forbade public money from being "directly or indirectly . . . used, granted, paid, or distributed to any health care provider[] . . . that provides or facilitates the provision of a procedure or treatment . . . prohibited under [s]ection 161.702." Tex. Health & Safety Code § 161.704 (emphasis added). The undefined term "facilitate," of course, ordinarily means "to make easier" or "to help bring about." It follows that "any health care provider" who helps bring about a prohibited procedure or treatment — whether provided by a "physician" or another "health care provider" — cannot lawfully receive public funding for that venture.

For good reason, too, given that the multidisciplinary path to medically transitioning children often starts with mental "health care." Mental health professionals serve as the "clinical gatekeepers whose assessments and recommendations initiate the interventions" prohibited by S.B. 14. Likewise, the Legislature acknowledged this in creating a limited "wean off" period for children on a course of treatment "that . . . began before June 1, 2023" so long as the child also "attended 12 or more sessions of mental health counseling or psychotherapy . . . at least six months before the . . . treatment . . . began." Tex. Health & Safety Code § 161.703(b). Even the World Professional Association for Transgender Health publicly professes that "mental health professional[s]" possess "the most appropriate training and dedicated clinical time to conduct an assessment and elucidate treatment priorities and goals when working with transgender youth." Standards of Care, Version 8 (2022).

To be sure, S.B. 14 also "amend[ed] the licensing act for physicians." Subsection 164.0552(a) of the Occupations Code now makes clear that the provision of a prohibited surgery or prescription is "a 'prohibited practice' that requires revocation of a physician's 'license or other authorization to practice medicine.'" Tex. Att'y Gen. Op. No. KP-0481 (2025) at 4. But this does not change the plain-text reality discussed above. If anything, the supplemental constraint on physicians' licenses sits comfortably beside the Council's independent obligation to discipline health care providers who transgress the Occupations Code's profession-specific "chapter[s]" or associated "rule[s]." Tex. Occ. Code §§ 501.401(1), 502.351(9), 503.401(a)(1), 505.451; see also id. § 507.404(2).

Psychologists, for example, are bound by rule to "rely on scientifically and professionally derived knowledge when making professional judgments," 22 Tex. Admin. Code § 465.10; act in their client's best interest, id. § 465.13(a)(4); and end the professional relationship if it is reasonably clear that the client "is being harmed by continued service," id. § 465.21(c). Other licensees within the Council's ambit are similarly bound to "provide services within accepted professional standards of practice" (social workers); avoid dishonestly representing the "effectiveness of services" (professional counselors); and use therapeutic services that assist with "stabilizing," "alleviating," or "overcom[ing]" a child's underlying condition (marriage and family therapists).

We have made clear that "[a]ny person that . . . facilitates these procedures or treatments could be engaged in child abuse, whether that be parents, doctors, counselors, etc." Tex. Att'y Gen. Op. No. KP-0401 (2022) at 12. Texas law also compels reporting by professionals — i.e., "an individual who is licensed . . . by the state" and "in the normal course of official duties for which [that] license . . . is required, has direct contact with children," Tex. Fam. Code § 261.101(b) — with reasonable cause to believe a child has been or may be abused. See id. § 261.109(a-1). As such, health care providers who are criminally convicted for these offenses would necessarily invite revocation of their licenses by the Council. See Tex. Occ. Code § 53.021.

Summary

The definition of a "health care provider" in subsection 161.701(2) of the Health and Safety Code unambiguously encompasses the professions regulated by the Texas Behavioral Health Executive Council. Any licensee that facilitates the provision of unlawful procedures or treatments that aim to transition a child's sex are thus forbidden from receiving public money in support of those efforts and, separately, risk revocation of their licenses to practice.

Very truly yours,

KEN PAXTON
Attorney General of Texas

BRENT WEBSTER, First Assistant Attorney General
LESLEY FRENCH, Chief of Staff
D. FORREST BRUMBAUGH, Deputy Attorney General for Legal Counsel
JOSHUA C. FIVESON, Chair, Opinion Committee
AMANDA K. ROMENESKO, Assistant Attorney General, Opinion Committee