Robyn Stevens Brody/Sipa USA/AP
Since President Donald Trump returned to the White House, he’s been vowing to stamp out gender-affirming medical care—what his administration terms “sex-rejecting procedures”—for young people diagnosed with gender dysphoria. Now, his administration is specifically going after the health care of trans kids from low-income families. On Tuesday, the Centers for Medicare & Medicaid Services released a final rule forbidding Medicaid and the Children’s Health Insurance Program from paying for puberty blockers and hormone therapy to treat gender dysphoria, as well as the surgeries provided in rare cases to older teens.
The Medicaid part of the rule applies to patients under age 18, while the CHIP provision applies to patients under 19. The rule will take effect in October, with one exception: For patients already on cross-sex hormones, coverage for those medications will continue for an additional six months to allow for a “limited tapering period,” according to the final rule.
A second rule—the so-called “nuclear weapon” designed to force hospitals nationwide to stop providing gender-affirming care for trans kids, or lose all Medicaid and Medicare funding for all their patients—is now scheduled to be finalized by December.
Gender-affirming medical treatments for minors remain supported by virtually all leading US medical associations.
Gender-affirming medical treatments for minors remain supported by virtually all leading US medical associations. But the Trump administration, no stranger to “alternative facts,” commissioned its own report criticizing trans youth healthcare last year—a project spearheaded by conservative activist Leor Sapir and authored by outspoken critics of gender-affirming care for minors. Their report, published by the Department of Health and Human Services, “misrepresents the current medical consensus and fails to reflect the realities of pediatric care,” American Academy of Pediatrics president Susan Kressly said at the time. Yet the final Medicaid and CHIP rule issued Tuesday heavily cites the Sapir team’s report as evidence for why the new restrictions on coverage are justified.
In announcing the rule, CMS administrator Mehmet Oz denied the demonstrated benefits of gender-affirming care for trans kids’ mental health. “Children deserve our protection, not experimental interventions that pose serious risks and convey no proven benefits,” Oz told Fox News in an exclusive on Tuesday announcing the final rule. “By cutting off federal funds for these sex-rejecting procedures, we’re following the science, saving taxpayer dollars, and, most importantly, protecting children from potentially irreversible harm so they can truly flourish.”
“We know what this is—a dangerous and unnecessary attempt to prevent transgender and nonbinary young people from accessing the best-practice health care they need to lead healthy and happy lives,” said Rodrigo Heng-Lehtinen, of the LGBTQ youth suicide-prevention group the Trevor Project, in a statement on Tuesday. “The Trevor Project’s research shows that access to this care is associated with significantly lower rates of depression and suicide risk among transgender and nonbinary young people who receive it.”
Twenty-six states have outlawed gender-affirming treatments for minors since 2022, in response to a coordinated campaign by religious-right and anti-LGBTQ activists. Since Trump returned to office and started threatening providers of transgender healthcare with defunding and prosecution, dozens of hospitals in both Democratic and Republican-led states have preemptively ended gender-affirming treatments to minors. Since then, families of young people diagnosed with gender dysphoria have been forced to travel long distances—or uproot their lives entirely—to get their kids to providers still offering treatment. As a result, the attacks on trans youth healthcare already hit poorer families the hardest.
Nearly 35,000 public comments were received on the new Medicaid and CHIP rule, with over 90 percent of commenters opposing it. As I reported in April, many of them were the parents of transgender children, who pleaded with the government to not proceed:
For a teenager struggling with gender dysphoria, a break in treatment could mean their body proceeds with the puberty of their birth sex, with potentially severe mental health consequences. Blair’s mom worried about her son losing not just his medication, but also the counseling, regular blood tests, and side-effect monitoring he received from his team at the MetroHealth clinic. So after taking some time to think, she wrote a comment on Regulations.gov, beseeching the government to stay out of her family’s personal business.
“I have learned that my original vision of what my child’s life would look like is very different from reality—and yet, this version is just as beautiful, if not more so,” she wrote. “That is why I find it so hard to understand why the government would try to interfere in such personal and medically complex matters.”
She’s not the only parent pleading with the Department of Health and Human Services not to cut off their child’s treatment. “Every decision I have made as a parent is to keep my kid healthy and safe,” wrote one of the 30,000-some public commenters on the proposed regulation. “In an emerging culture where parents’ choice is so important to school and child development policies, why is my choice to consult with my child’s medical team and make informed decisions being taken away and infringed on?”
LGBTQ rights organizations have said they intend to take the issue to the courts. “The rule announced today will face legal challenge,” GLBTQ Legal Advocates and Defenders announced in a statement Tuesday after the final rule was released.
“Despite this being called a ‘final rule,’ we have time to fight back,” Heng-Lehtinen added. “Nothing will change overnight—and this rule would not ban this care nationally, nor would it ban hospitals from providing these services. We will continue working closely with our partners and allies across the country to stop this dangerous rule, and to create a country where all young people can receive the best-practice health care they need.”
