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AUSTIN (KXAN) — Therapists, counselors and other mental health professionals could be subject to legal liability under Texas’ ban on transition-related health care for minors, according to a legal opinion released Monday by Texas Attorney General Ken Paxton.

Senate Bill 14, which passed in 2023, bans surgeries (extremely rare) and medications for the purpose of a minor’s gender transition. It also prohibits billing a state health insurance plan for those treatments. The bill doesn’t mention mental health care.

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The law specifically applies to physicians and “health care provider[s],” which the law defines as someone “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.”

Violations of SB 14 can lead to revocation of a state license or credential. Recently, the Attorney General’s Office has sued doctors for allegedly providing care after the law’s deadline.

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The legal opinion was issued after a request by Darrel D. Spinks, executive director of the Texas Behavioral Health Executive Council (TBHEC). Per the opinion, he had asked if SB 14 covers the council’s licensees and how they could be affected.

“The Council’s licensees plainly constitute health care providers… resulting in a bar on all public funds for those who facilitate prohibited procedures—in addition to the longstanding constraints on licensed practice,” Paxton wrote.

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It further declares that the law states public funds cannot be used to “facilitate” the proscribed procedures, and that mental health care given prior to any other treatment counts.

“For good reason, too, given that the multidisciplinary path to medically transitioning children often starts with mental ‘health care,’” the opinion states. “We received several briefs highlighting that mental health professionals serve as the ‘clinical gatekeepers whose assessments and recommendations initiate the interventions’ prohibited by SB 14.”

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Paxton also noted the state’s mandatory reporting requirements demand that mental health providers report colleagues who assist with a minor’s transition. In a prior opinion, the AG declared this was “abuse.”

The opinion comes as Paxton faces a tough primary battle for one of Texas’ seats in the U.S. Senate. He’s currently polling near incumbent Sen. John Cornyn, with U.S. Rep. Wesley Hunt also in the race.

You can read the full opinion below:

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