2026 Voter Guide: This article is part of Johnstown Republic’s guide to the Nov. 3 ballot.
Colorado voters will decide Proposition 135, a citizen-initiated measure that would prohibit certain surgeries on minors when the purpose is to alter biological sex characteristics in response to the minor’s perception of sex or gender.
The measure would also prohibit state or federal funds, Medicaid reimbursement and insurance coverage from paying for surgeries prohibited under the measure. Proposition 135 would change state law and requires a simple majority to pass, according to the official Colorado General Assembly ballot analysis.
What would Proposition 135 do?
Proposition 135 would prohibit a health-care professional or other person from knowingly providing or arranging a surgery for a person under 18 when the purpose is to alter the minor’s biological sex characteristics in response to the minor’s perception of sex or gender.
The official measure text uses the broader legal wording “performing, prescribing, administering, or providing” such surgery.
The measure defines “altering biological sex characteristics” as treatment in response to a minor’s perception of sex or gender. Because the definition focuses on the purpose of the treatment rather than listing particular procedures, the Legislative Council fiscal analysis says the measure could also affect surgeries involving non-transgender minors if the treatment is interpreted as being in response to the minor’s perception of sex or gender.
The prohibition would not apply to:
- Treatment for a medically verifiable disorder of sex development;
- Treatment for acquired physical or chemical abnormalities; or
- Male circumcision.
The measure does not restrict social-transition options or counseling. The state fiscal analysis specifically identifies those non-surgical forms of care as outside the prohibition.
If approved, Proposition 135 would take effect Jan. 1, 2027, and apply to violations occurring on or after that date.
How would insurance and public funding change?
Proposition 135 would prohibit the use of:
- State funds;
- Federal funds;
- Medicaid reimbursement; and
- Insurance coverage
to pay for surgeries prohibited by the measure.
Under current Colorado law, some medically necessary gender- or sex-related care may be covered through public or private health plans. Proposition 135 would bar those payment sources from covering surgeries that fall within the new prohibition.
The state fiscal analysis says Colorado’s three major pediatric surgical providers — Children’s Hospital Colorado, Rocky Mountain Children’s and Denver Health — reported that they do not currently perform gender- or sex-based surgeries on transgender patients under age 18.
What does a YES vote mean?
A YES vote would prohibit the covered surgeries on minors and prohibit government funding, Medicaid reimbursement and insurance coverage from paying for them.
The restrictions would begin Jan. 1, 2027.
What does a NO vote mean?
A NO vote would leave current Colorado law in place.
Existing laws governing medical treatment for minors would continue to apply, and existing public and private insurance rules would continue determining whether qualifying procedures are covered.
What would it cost?
The Legislative Council Staff fiscal analysis projects no measurable change in state revenue or appropriated state spending in fiscal years 2026-27 or 2027-28.
State Medicaid and public employee health plans could experience small savings if they no longer pay for surgeries prohibited by the measure, but those savings are expected to be minimal because use of the procedures among minors is low.
The Department of Regulatory Agencies would have additional workload to update rules and materials and respond to complaints involving medical professionals or insurers. Courts could also see additional civil cases involving disputes over the measure, although those effects are expected to be minimal.
Local governments could experience similarly small reductions in employee health-insurance costs.
Arguments for and against
Supporters argue that minors should not undergo surgeries that can produce permanent physical changes before reaching adulthood. They contend that less invasive forms of care remain available and that irreversible surgical procedures should be delayed until a person can make the decision as an adult.
Opponents argue that the measure is written broadly enough to interfere with medically necessary care for both transgender and non-transgender minors. They also argue that treatment decisions should remain with families and medical professionals and that the measure could create uncertainty over which procedures are prohibited.
Those arguments are summarized from the official Colorado Blue Book analysis.
The Blue Book also notes that these procedures are rare among minors. A national study using 2019 insurance claims found an estimated 2.1 gender-affirming surgeries per 100,000 transgender or gender-diverse youths ages 15 to 17, with substantially lower rates among younger adolescents.
Colorado’s three major pediatric surgical providers also report that they do not perform gender- or sex-based surgeries on transgender patients under age 18.
What does this mean for Johnstown?
Proposition 135 would apply statewide, including to health-care providers, insurers and families in the Johnstown area.
The measure contains no provisions specific to Johnstown. Its local effect would depend primarily on whether a minor seeks a surgery covered by the prohibition and whether that procedure would otherwise be provided or covered by insurance.
Official information
The complete ballot analysis, measure documents and official text of Proposition 135 are available through the Colorado General Assembly’s Proposition 135 page.