JUST IN: In major effort to end gender-affirming care, Trump administration takes aim at hospitals

Donald Trump has taken a firm stand against using Medicaid to fund controversial gender surgeries for minors. By drawing a clear line, he emphasizes protecting children and preserving parental authority over life-altering medical decisions. Trump argues that public funds should reflect the values of mainstream America, not be used to advance divisive social agendas.

Supporters see this as a common-sense move focused on child welfare and accountability in government spending.

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The Trump administration is making its most forceful attempt yet at restricting gender-affirming care for transgender youth in the U.S.

The Centers for Medicare and Medicaid Services proposed on Thursday two rules to withhold federal funds in connection with gender-affirming care for trans minors, including puberty blockers, hormones, and surgery. The most stringent rule would bar facilities that offer this care from receiving any funding from the federal Medicare or Medicaid programs, a move that would effectively force most medical centers to cease providing it.

The agency also wants to prohibit Medicaid and Children’s Health Insurance Program funds from being spent on gender-affirming care for minors.

The public will have 60 days to submit comments on the proposed funding rules, after which the administration could change them or move to finalize them.

It’s unclear how long it will take CMS to finalize the rules, according to Hannah Oliason, an attorney at Nilan Johnson Lewis who works with hospitals. But with a substantial number of comments expected, it could take months or even a year. It’s possible the rules could become effective immediately after that, though. If they change substantially from the proposals, there would likely be more of a transition period, Oliason said.

The proposals from CMS mark the latest of a slew of attempts by the Trump administration and Republicans to roll back access to this care for trans youth. It’s a campaign that started a week into President Trump’s term with an executive order that sought to ban transgender health care for people under 19. The order was later blocked by a federal judge.

Underscoring the breadth of the administration’s efforts, in a press conference Thursday morning, health secretary Robert F. Kennedy Jr. noted that the Food and Drug Administration sent warning letters to manufacturers of chest binders, which many nonbinary and trans masculine people use to flatten their chests. The letters tell the firms to stop marketing the devices to children with gender dysphoria.

Trump administration leaders and the authors of a recent federal report on gender dysphoria emphasize that therapy and social transition without medical assistance should be prioritized for children. Providers who work with trans children say that these components are already part of the standard of practice.

“These policies and proposals misconstrue the current medical consensus and fail to reflect the realities of pediatric care and the needs of children and families,” Susan J. Kressly, president of the American Academy of Pediatrics, said in a statement. She said the proposals should be withdrawn. “These rules help no one, do nothing to address health care costs, and unfairly stigmatize a population of young people.”

The Department of Health and Human Services also sewed up existing loopholes surrounding gender dysphoria, proposing a reversal to a 2024 Biden administration update to a landmark disability law that expanded the definition of disability to include gender dysphoria.

On Thursday afternoon, the House passed a bill with the same goal as one of the CMS proposals: to ban Medicaid from covering gender-affirming care for trans youth. The measure is unlikely to pass the Senate, where it needs 60 votes. On Wednesday, it passed a bill banning clinicians from providing gender-affirming care to trans minors, which is also unlikely to pass the Senate.

At the press conference, Kennedy said that gender-affirming care “inflicted lasting physical and psychological damage on young people. “This is not medicine,” he continued. “This is malpractice.”

Clinicians, patients, and advocates who have spent years providing, receiving, and learning about the care maintain that it’s evidence-based and often lifesaving. But federal health leaders and speakers at Thursday’s event made repeated comments likening transgender identity to a political “war” on biology and denying the existence of transgender people.

Deputy health secretary Jim O’Neill said that to deny what he sees as the “fundamental truths” of biology constitutes “a hatred for nature as God designed it, and for life as it was meant to be lived.” He said that there are only two genders, and that to claim otherwise is “evil.”

Historians have documented evidence of gender diversity throughout human history. “Transgender young people are very, very real,” said Kellan Baker, a senior adviser for health policy at the nonprofit think tank Movement Advancement Project. “And their health care needs are very, very real.”

Kennedy accused the Biden administration — which used regulation to allow federal nondiscrimination disability laws to apply to gender dysphoria — of serving “the commercial interest of a predatory, multibillion dollar industry.”

In response to a reporter’s question, CMS Administrator Mehmet Oz estimated that “at least” $250 million may have been spent over 10 years by Medicare and Medicaid on gender-affirming care for minors. The federal government spends about $840 billion a year on Medicaid and another $580 billion on Medicaid and CHIP, according to an analysis from KFF.

The idea that providers and any groups that offer gender-affirming services are motivated by profit in a predatory scheme continued throughout the press conference.

“We are not going to let these taxpayer dollars go on to hurt children,” Oz said.

Sen. Roger Marshall (R-Kan.), a physician, told STAT that he and his colleagues are ready to use their powers to support the administration. Earlier this year, Marshall introduced a bill, alongside Sen. Bill Cassidy (R-La.), who chairs the Senate health committee, to ban federal health insurance programs from funding gender-affirming services. Both were present at the HHS press conference on Thursday.

Withholding federal funds
Both proposed rules hones in on what the text refers to as “sex-rejecting procedures,” which includes any medication or surgical procedure that “attempts to align an individual’s physical appearance or body with a stated identity that differs from the individual’s sex.” Like the state laws banning gender-affirming care that preceded the Trump administration’s action, each proposed rule includes exceptions for presumably cisgender children with intersex traits, as well as for those broadly with a physical disorder, injury, or illness.

The Children’s Hospital Association and Physicians for Reproductive Health also condemned the proposed rules Thursday.

It’s not the first time the administration has attempted to stop Medicaid from funding this kind of pediatric care. Over the summer, early versions of Trump’s tax-cut bill included provisions that would have prevented Medicaid and the Children’s Health Insurance Program from funding gender-affirming care, though they were ultimately struck from the final version.