Trump administration proposes rules to cut funding for minors’ gender-affirming care

The Trump administration on Thursday proposed sweeping rules that would effectively strip federal funding from hospitals that provide gender-affirming care to minors. Health and Human Services Secretary Robert F. Kennedy Jr. announced that, if finalized, the rules would prevent Medicaid and Medicare reimbursements for providers that prescribe puberty blockers or hormone therapy, or perform surgical procedures for transgender youth.

The rules, issued by the Centers for Medicare and Medicaid Services, would bar participating hospitals from offering puberty blockers, hormone therapy, or surgeries to minors as a condition of Medicare and Medicaid participation, and would block funding for such care through Medicaid and the Children's Health Insurance Program. The proposals are not final and would need a 60-day public comment period before taking effect, and are expected to face legal challenges. The American Civil Liberties Union argued the proposals are unconstitutional and tentatively plans to sue if enacted. "These gratuitous proposals are cruel and unconstitutional attacks on the rights of transgender youth and their families," Chase Strangio, a leading ACLU LGBTQ rights attorney, said in a statement. "The latest proposals from the administration would force doctors to choose between their ethical obligations to their patients and the threat of losing federal funding." Shannon Minter, a lawyer at the National Center for LGBTQ Rights, said these rules "wage an attack on the lowest-income Americans’ ability to access health care."

During the news conference, HHS also announced that the Food and Drug Administration will issue warning letters to 12 manufacturers of breast binders for minors, which are used to flatten breast tissue, alleging that these retailers are engaged in illegal marketing to trans youth. In addition, HHS proposed revising Section 504 of the Rehabilitation Act of 1973, which bars discrimination in federally funded programs, to exclude gender dysphoria from the definition of "disability." Doing so would undo a Biden-era rule that recognized gender dysphoria as a disability that could serve as a legal basis for transgender people to fight discrimination in health care, housing and education.

Dr. Mehmet Oz, the administrator of CMS, called these “part of an all-government action to protect all vulnerable individuals.” "I will use every tool at my disposal to fight this proposal and protect transgender Americans and their families." New York Attorney General Letitia James, in a statement, called the administration’s actions "reprehensible." Trump’s Justice Department has tried— and failed— several times to indict James in a mortgage fraud case. "I will use every tool at my disposal to fight this proposal and protect transgender Americans and their families," James said.

Even though access to this care is still legal in blue states like New York, which passed constitutional protections for gender-affirming care and abortion, these new rules could further restrict an already constrained environment for trans care. Since 2020, 27 states have enacted measures prohibiting access to affirming care. In June, the Supreme Court ruled that a Tennessee ban on such care did not violate the Constitution. This climate has forced families who can afford it to travel to states where care remains legal and accessible. "Once again, Republicans have chosen to place the government between American families and their doctors," Sen. Ron Wyden, a Democrat representing Oregon, said in a statement. "Trump’s latest effort to bully hospitals into carrying out his extremist agenda is a cruel and thoughtless step that contradicts medical evidence and will jeopardize health care for many communities around the country. Our trans neighbors, family members and friends deserve better." The Republican-led House on Wednesday passed a bill from outgoing Rep. Marjorie Taylor Greene that would allow health providers to be charged with a felony and imprisoned up to 10 years if they prescribe hormones or puberty blockers or perform surgeries for trans people under 18 years old. The measure, which marks the first time a national ban on trans youth care has reached Congress, will now head to the Senate, where it is expected to face challenges. It is unclear how much Medicaid reimbursements paid for gender-affirming care for trans youth nationwide, but reporters in Mississippi found that only a "tiny fraction" of the state’s Medicaid budget was used to pay for trans care services there.