US moves to block gender-affirming care for children, threatens Medicare and Medicaid funding for hospitals

The US Department of Health and Human Services (HHS) on Thursday (December 18) unveiled a sweeping set of regulatory proposals that would effectively bar access to gender-affirming care for minors, marking the Trump administration’s most aggressive move yet to restrict medical treatment for transgender children.

The proposed actions would cut off Medicare and Medicaid funding to hospitals that provide puberty blockers, hormone therapy or surgical interventions for minors and prohibit federal Medicaid dollars from being used to pay for such care. The restrictions would also apply to the State Children’s Health Insurance Program (CHIP), according to a federal notice.

“This is not medicine, it is malpractice,” Health Secretary Robert F. Kennedy Jr. said at a news conference. “Sex-rejecting procedures rob children of their futures.”

Impact across states

More than half of US states already restrict or ban gender-affirming care for minors. However, the federal proposals could significantly affect access in nearly two dozen states where such treatments remain legal and, in some cases, covered by Medicaid using a mix of federal and state funds.

Nearly all US hospitals participate in Medicare and Medicaid, the federal government’s largest health insurance programs for seniors, people with disabilities and low-income Americans. Losing access to those payments would threaten the financial viability of most hospitals and could further discourage providers from offering gender-affirming care for children.

Many hospitals have already halted such care in anticipation of federal action, according to healthcare advocates.

Additional regulatory moves

Kennedy also announced that the HHS Office of Civil Rights will propose a rule excluding gender dysphoria from the federal definition of a disability. In a related move, the Food and Drug Administration issued warning letters to a dozen companies that market chest-binding vests and similar products used by people with gender dysphoria.

The FDA said such products can only be legally marketed for approved medical uses, such as post-mastectomy recovery. Companies receiving letters include GenderBender LLC of California and TomboyX of Seattle.

Rules not yet final

The proposals are not legally binding at this stage. Federal agencies must complete a formal rulemaking process that includes public comment periods and revisions before the rules can take effect. Legal challenges are widely expected.

Even so, healthcare experts warn the proposed restrictions could have an immediate chilling effect on providers, particularly given the financial risks associated with losing federal funding.

Medical community opposition

The proposed rules run counter to guidance from major medical organizations, including the American Medical Association, which has urged governments not to restrict care for gender dysphoria and has said such treatments can be medically appropriate for some patients.

Gender-affirming care for minors typically begins with psychological evaluation and may involve social transition, such as changes in name or pronouns. Some patients later receive puberty blockers or hormone therapy. Surgical procedures are rare for minors, according to medical groups.

Broader political context

The HHS actions build on a broader push by President Donald Trump and Republicans in Congress to roll back protections for transgender Americans.

On his first day back in office, Trump signed an executive order stating that the federal government would recognize only two sexes — male and female. He has also signed orders aimed at cutting federal support for gender transitions for people under 19 and barring transgender athletes from participating in girls’ and women’s sports.

On Wednesday, the US House passed a bill that would expose healthcare providers to prison time for treating transgender patients under 18. Another House measure under consideration would ban Medicaid coverage for gender-affirming care for children.

Legal landscape

Currently, Medicaid programs in fewer than half of US states cover gender-affirming care. At least 27 states have enacted laws restricting or banning such treatment. Federal judges have struck down bans in Arkansas and Montana as unconstitutional, though legal battles in those states are ongoing.

(With AP inputs)