No one knew exactly what to expect after lawmakers passed a proposal last year making Minnesota a refuge for those seeking gender-affirming care.

"Is it going to be five people moving here, or is it going to be hundreds?" said Aaron Zimmerman, executive director of the LGBTQ nonprofit PFund Foundation. "It's a huge lift to pick up your life and move, the cost of it alone."

In a span of six months after the law passed, more than 150 people have said they're planning to move to Minnesota alone or with their families from states as far away as Texas, Tennessee and Florida, according to an online survey put together by LGBTQ groups in the state. People who reached out for help were directed to the survey, though groups think the number of families moving is higher. The influx is prompting legislation this session seeking funding to help people relocate here.

"Minnesota really is an island unto itself," said Zimmerman, whose nonprofit worked with Twin Cities Pride and the Minnesota Trans and Intersex Resource Network to create the survey. "Minnesota has a reputation and long history of protecting LGBTQ people. That reputation is the crux of this."

They're coming from some of the more than 20 states that have enacted policies that ban or restrict gender-affirming care for minors. Nearly 90% of respondents said they are moving in order to get that care in Minnesota, creating a crunch for providers, who were already struggling to meet demand and trying to chip away at waitlists of a year or longer.

"It's a myth that's perpetuated that somehow this care is really fast and really easy to access, and that's just not the reality for anyone, even for Minnesotans who live here in a state with protections," said Dr. Angela Kade Goepferd, chief education officer and medical director of gender health at Children's Minnesota.

Children's saw a more than 30% increase in new patient calls in 2023 that coincided with gender-affirming care restrictions cropping up across the country. Although Children's has hired an additional provider and increased the number of days care is provided, the waitlist is still between 12 and 15 months, Goepferd said.

They've already seen 12 patients from outside Minnesota since the start of the year. Between 2019 and 2023, Children's saw only a handful of people from other states.

"We've been trying to get patients off the list and triage those with more urgent needs because they're running out of a medication or something, verses those who are seeking to establish care," Goepferd said. "We're just getting to the point now where we're starting to pull people off our waiting list from other states."

Minnesotans who live in an area where there are no providers are also struggling to get appointments.

Jenna Fuchs realized there was no one in her central Minnesota community who could do pediatric appointments for her 10-year-old transgender son, Cam. They found a provider at Hennepin Healthcare in Minneapolis but had to wait six months for their first appointment. She has to take a half day off work and travel for every visit.

"Part of expanding access to trans health care across Minnesota is so that people have the choice of where they want to live and can receive care in the community they call home," Fuchs said.

Family Tree Clinic in Minneapolis has been offering hormone treatments for nearly a decade and now sees about 3,000 patients a year for 7,000 appointments. Those numbers are rising.

Last year, the clinic saw 225 patients from out of state, many of them pediatric patients from Iowa or other bordering states, as well as places such as Texas, Florida, Ohio, Missouri, Indiana and Kansas.

Family Tree Clinic executive director Annie Van Avery said the clinic operates on a sliding fee system, which means charges are based on a patient's income. They try not to turn away patients who are struggling to pay for their care, and some patients traveling from out of state haven't been able to get coverage from their insurance. The community clinic relies on reimbursement from health care companies, fundraising and state and county grants to stay afloat.

"We have received more demand but no more revenue from the state to subsidize our care. So expenses are rising and revenue is lower," she said. "We're welcoming people with open arms, and we're making it accessible and possible to get health care with us, but we are really struggling and really needing more support."

The transgender refuge law that went into effect last April protects transgender people, their families and medical practitioners from extradition orders and legal repercussions for traveling to Minnesota to receive gender-affirming care. That care often includes support for families, counseling and medication such as hormone blockers to prevent puberty.

Rep. Leigh Finke, DFL-St. Paul, said she thinks all the time about "the people we invited to come to Minnesota and how we are going to be able to take care of them."

"The responsibility of victory is that we pushed this bill through and now it's up to us to make good on it," said Finke, Minnesota's first transgender lawmaker, who sponsored the proposal. "I've talked to the governor and lieutenant governor and everybody that I can to say: 'Our community is coming to Minnesota because we said it was a safe place for them to come.'"

This year, Finke is carrying legislation to allocate $1 million for state grants to the PFund Foundation, which gives to LGBTQ organizations across the state. The grants would be used specifically to help individuals and their families in the process of relocating to Minnesota or who have recently moved.

Finke has also tried to recruit gender-affirming care providers to move to Minnesota to help with the waitlists, but she said transgender people are coming here for more than care.

"They are also leaving environments where they are being attacked constantly. They are facing bullies and attorneys general who are attacking their rights," she said. "They're coming to a place where they're safe."