In a sweeping move that could shut down gender-affirming surgeries for minors across the United States, the Trump administration has proposed rules that would strip hospitals and doctors of federal Medicare and Medicaid funding.
Funding Cuts Target Minor Gender-Affirming Care
The proposal, unveiled Thursday by the Department of Health and Human Services, is part of a broader effort to curtail gender-affirming care and could effectively ban the practice nationwide if finalized.
Health Secretary’s Statement
Health Secretary Robert F. Kennedy Jr. told reporters that the administration would not stand by while “ideology, misinformation and propaganda push vulnerable young people into decisions they cannot fully understand and that they can never reverse.” He added, “This is not medicine. It is malpractice.”
President Trump’s Priority
President Trump has made ending gender-affirming care a campaign priority, and the new rules aim to eliminate funding and programs that recognize gender dysphoria among children and the existence of genders beyond male or female.
Medicaid Coverage Restrictions
The first rule would prohibit Medicaid from covering any medical care for transgender patients younger than 18 and would bar reimbursements through the Children’s Health Insurance Program (CHIP) for gender-affirming care for patients under 19.
Medicare Funding Block
The second rule would block all Medicaid and Medicare funding for any services at hospitals that provide pediatric gender-affirming care.
Impact on Hospitals
Because virtually every hospital in the country relies on Medicare funding, the rule would have a wide-ranging impact and could likely make gender-affirming care inaccessible nationwide.
Medicare and Medicaid Spending
According to Kaiser Family Foundation, Medicare and Medicaid account for nearly 45 percent of spending on hospital care, underscoring the financial weight of the proposed cuts.
State Coverage Landscape
Approximately 17 state Medicaid programs currently cover gender-affirming care procedures for children, while 27 states have bans or restrictions on such procedures.
State Funding Possibility
The rules do not prohibit states from using their own funds to reimburse providers for transgender care, but the costs would be prohibitive for many state budgets.
HHS Rationale
HHS stated in the Medicaid rule that “protecting children enrolled in Medicaid and CHIP from the harms of sex-rejecting procedures, including possible long-term and irreversible harms, outweighs the possible financial costs some states may experience if they begin to pay with state funds the full cost of sex-rejecting procedures for children enrolled in Medicaid and CHIP.”
Advocates’ Reaction
Advocates have criticized the effort as an attempt to eliminate needed care, noting that the rules are still proposals and not yet final.
Human Rights Campaign’s Warning
Kelley Robinson, president of the Human Rights Campaign, said in a statement, “Make no mistake: these rules aim to completely cut off medically necessary care from children no matter where in this country they live.”
HRC Clarification
Robinson also warned that “the Trump administration aims to force providers into an impossible choice: stop providing health care to trans youth in order to protect federal funding for every other patient.” She added that “these rules are proposals, not binding law.”
Physicians for Reproductive Health’s View
Jamila Perritt, president and CEO of Physicians for Reproductive Health, described the rules as a “lose-lose situation” for providers and hospitals, where “lives are inevitably on the line.” She said, “In an effort to strongarm hospitals into participating in the administration’s anti-LGBTQ agenda, the Trump Administration is forcing health care systems to choose between providing lifesaving care for LGBTQ+ young people and accepting crucial federal funding.”
FDA Warning Letters
On the same day, the Food and Drug Administration announced that it would issue warning letters to 12 manufacturers of breast binders for “illegal marketing” to children.
FDA’s Statement
Kennedy told reporters that the FDA is telling these companies that “the illegal marketing of breast binders to children for the purpose of treating gender dysphoria commits significant regulatory violations and requires swift congressional or corrective action.”
Breast Binders Explained
Breast binders are compression garments worn to help women recover from mastectomies and are also used to masculinize a person’s chest and reduce gender dysphoria.
Executive Order Context
The new rules follow an executive order signed by President Trump that withheld federal funding from hospitals and medical schools and directed agencies to take steps to prevent essential gender-affirming treatments, including surgeries, hormone therapy, and puberty blockers.
Additional Trump Actions
In the months that followed, the Trump administration also cancelled a federal suicide prevention hotline specifically for transgender youth and cut hundreds of millions of dollars in scientific research funding related to LGBTQ people.
Deputy Secretary O’Neill’s Statement
Health and Human Services Deputy Secretary Jim O’Neill said during the press conference announcing the new policies, “Men are men. Men can never become women. Women are women. Women can never become men. Children are innocent and need our protection.”
Comment Period and Legal Challenges
The proposed rules will be open to a 60-day public comment period before they are finalized and are likely to face legal challenges.
Congressional Context
They come one day after House Republicans passed a package of health care bills that would make it a crime to offer gender-affirming care to transgender minors, punishable by a fine or up to 10 years in prison, with the bill sponsored by Rep. Marjorie Taylor Green (R-Ga.).
House Vote on Medicaid Coverage
The House will also vote Thursday on a measure led by Rep. Dan Crenshaw (R-Texas) that would prohibit Medicaid coverage for gender-affirming medical care for those under 18.
Senate Prospects
Neither bill is likely to advance in the Senate, where they would need 60 votes to pass.
Closing Summary
The administration’s proposal, combined with congressional action, marks a significant escalation in the fight over gender-affirming care for minors and underscores the intense political divide over the issue.
