"actual or perceived" identity. However, protections for hate crimes motivated on the basis of a victim's gender identity or sexual orientation is limited to "crime affect[ing] interstate or foreign commerce or occur[ring] within federal special maritime and territorial jurisdiction." This limitation only applies to gender identity and sexual orientation, and not to race, color, religion or national origin. Therefore, hate crimes which occur outside these jurisdictions are not protected by federal law. 22 states plus Washington D.C. have hate crimes legislation which includes gender identity or expression as a protected group. They are Vermont, Massachusetts, Connecticut, New Jersey, Delaware, Illinois, Maryland, Missouri, Minnesota, Colorado, New Mexico, Nevada, Rhode Island, Washington, Oregon, California, Hawaii, Maine, Tennessee, Puerto Rico, Utah, Virginia and New York. Twenty-seven states have hate-crimes legislation which exclude transgender people. Six states have no hate-crimes legislation at all. Numerous municipalities have passed hate-crime legislation, some of which include transgender people. However Arkansas, North Carolina and Tennessee recently passed laws which ban municipalities from enacting such protections for sexual orientation, gender identity or expression. Healthcare Transgender people confront two major legal issues within the healthcare system: access to health care for gender transitioning and discrimination by health care workers. Treatment for children The following states currently ban gender-affirming healthcare for people under 18: Utah: On January 27, 2023, Governor Spencer Cox signed the bill. South Dakota: On February 13, 2023, Governor Kristi Noem signed the bill. Mississippi: On February 28, 2023, Governor Tate Reeves signed the bill. Tennessee: Passed in February 2023. Governor Bill Lee is expected to sign it. Florida: A state Board of Medicine rule is expected to take effect on March 16, 2023. Similar attempts have been made elsewhere. Arkansas In April 2021, the Arkansas legislature overrode the governor's veto to enact a law banning health care providers from treating children under 18 with hormones, puberty blockers, or sex reassignment surgery, and from referring them to other providers. Similar bills have been proposed in at least 20 other states. (South Dakota's bill would make it a felony for healthcare providers to provide this care, and it includes an exception to allow them to perform surgeries on intersex children meant to make them fit into the gender binary.) The American Civil Liberties Union of Arkansas sued the state, and a federal judge issued an injunction preventing the law from taking effect, saying the law would cause "irreparable harm"