Josie had put off packing long enough. It was time to make some tough decisions about what to bring and what to leave behind. The high school sophomore from St. Augustine, Fla. sat on her bed one recent morning while her mom Sarah pulled clothes from her closet.

It held a trove of good memories — like the red dress Josie wore to the winter homecoming dance. And the pink cover-up she sported at a friend's pool party.

Good times like these have felt scarce lately. Josie, who's transgender, no longer feels welcome in Florida.

Her family requested they be identified by their first names only, fearing retaliation in a state where Republican Gov. Ron DeSantis and other officials have politicized and passed anti-trans policies in health care and education.

Conservative states across the country are pushing a record number of bills that target LGBTQ rights, particularly transgender rights. That's forced residents like Josie to rethink where they want to call home.

In just a few days, Josie was moving more than a thousand miles away from St. Augustine – and her parents – to start a new life in Rhode Island. Her aunt and uncle live outside Providence, and she'll stay with them and attend high school nearby.

Her mom Sarah held up outfit after outfit and asked, "Staying or going?"

The formal dress could stay. Cardigans and overalls went in the suitcase. At one point, the family dog Reesie crawled past the luggage to snuggle up to Josie.

"She has, like, a sense when I'm sad, and she just comes running in," says Josie, 16.

Moving to Rhode Island had been "Plan B" for awhile, but Josie says she never thought it would actually happen. But a lot has changed in the last year.

"It's unbelievable how far the state has fallen," she says.

What drove Josie to leave

Florida is one of more than a dozen states that have passed bans on gender-affirming medical treatments for minors, such as puberty blockers, hormone therapy and certain surgical procedures.

In Florida, the state medical boards began debating those bans last summer, and they went into effect in March. For months, Josie was terrified she would lose access to the hormones she takes to help her body align with her gender identity.

Most major national medical associations agree gender-affirming care is safe and effective. But the Florida medical boards argued the treatments were "experimental," and barred doctors from prescribing them to minors.

A provision in the new regulations meant that kids like Josie, who'd already started care, could continue with their treatments. But she didn't trust that would last.

She pointed to the fact that this spring the legislature considered forcing all trans youth to stop treatment by the end of the year, as part of a bill to bolster restrictions on transgender care.

"I thought that they would realize what they've done wrong and, you know, repeal some things," she says. "But they just kept going. It just became, like, too real, too fast."

Lawmakers ended up stripping that particular provision on May 4, just before the session ended, allowing kids like Josie to stay in treatment.

But she had already decided to leave.

School has been challenging at times since Josie came out as trans in 8th grade. Some childhood friends ended up rejecting her.

Josie wanted to play on the girls' tennis team, but a Florida law passed in 2021 bars trans women from competing on school teams meant for athletes assigned female at birth.

It was also painful when Florida teachers had to start watching what they said about LGBTQ issues, a result of the chilling effect from another recent Florida law, the Parental Rights in Education Law. Critics call that the "Don't Say Gay" law.

Josie noticed that at her school, stickers signifying that areas were "safe spaces" for LGBTQ people had been taken off classroom doors.

"Which is just ridiculous, like you want your students to be comfortable and safe," she says.

Other families also moving or planning to leave Florida

The new laws and anti-trans political rhetoric are hurting kids across Florida, says Jennifer Evans, a clinical psychologist at the University of Florida's Youth Gender Program in Gainesville.

"I'm seeing more anxiety, more depression," Evans says. "Things I hear patients say are, 'The government doesn't want me to exist.' They don't feel safe."

Many Republican-led states are pushing measures that tackle all sorts of gender-related issues — not just transgender health care, but what schools can teach or what bathrooms people can use.

Bills don't have to pass to cause harm, says Evans, who identifies as queer.

"It's a lot to feel like enough people in this country don't agree with your existence — which actually isn't affecting them – that people want to shut down other people's access to living complete and affirmed lives," she says. "It's painful to see that."

Four families who previously sought care at Evans' clinic have already moved out of Florida, she says, while another ten families have plans to leave later this year. Some older teens she treats are also planning to get out when they turn 18.

But moving isn't easy. Josie's dad Eric says that like many families, they had a lot at stake.

"You know, just financially it's difficult to uproot what we've set up," he says.

They've owned their home in St. Augustine for a long time. Eric recently started a new job, while Josie's mom Sarah works at a private college, which includes a benefit that allows Josie and her older sister to get reduced tuition at some colleges around the country.

So her parents decided that, at least for now, Josie would go live with her aunt and uncle and they would stay behind in St. Augustine.

It was a devastating and emotional decision to have to make.

"It was just terror in my heart, like you could just feel that cold burst in my chest just going all throughout my body, just a lot of shock" says Sarah. "I couldn't imagine what it would be like to wake up — like Josie's part of everything I do."

A new home and a "bombardment" of support

Josie will finish her sophomore year up north in Rhode Island before returning to St. Augustine for summer break. Her family sees it as a trial run for what could be years of separation.

One night before Josie left, she invited several friends over for a going away party. The teens played a dance video game, laughing as they tried to perform a hip-hop routine in sync.

Sarah brought out a black forest cake. "We love you Josie" was piped in frosting along the edge of the platter, framed by two hearts.

It was a simple but powerful send-off from the community support system Josie has relied on in Florida.

A few days later, she and her mom flew north to get Josie settled. Leaving her daughter in Rhode Island was "agony" for Sarah.

"I was a mess," she says. "I cried the whole way to the airport. I just felt I was going the wrong way."

Back in St. Augustine, Sarah is still adjusting to life without Josie at home, but they talk every day.

And Josie is getting used to her new environment in Rhode Island. The cooler weather is great, she says, and her aunt and uncle have been really supportive.

Her new high school is a little smaller than her old one, and in a more liberal area. Josie says in her first week she made at least one friend per day, and has since made more.

She loves seeing pride flags in the halls and plans to join the Gender and Sexuality Alliance Club. It all feels like a "bombardment of support."

"It was just like such a shock to me - like not a bad shock, but like just shocked that this is how schools can be, it's just that Florida's just choosing not to be like that," says Josie.

Gov. Ron DeSantis' office has not responded to several requests for comment to address the concerns of families like Josie's. The state has taken additional legal steps to restrict trans rights since she left in April.

Josie's parents say they will keep their pride flag waving in the front yard and advocate for equality while their daughter is away.

Josie says she also thinks about kids in Florida who can't leave, and she urges them not to give up hope.

But for right now, she needs to move on in her new life.

For support, call Trans Lifeline at 877-565-8860 or The Trevor Project at 866-488-7386.

This story comes from NPR's health reporting partnership with KFF Health News and WUSF.