The U.S. Department of Health and Human Services (HHS) announced Thursday a series of new regulations aimed at restricting gender-affirming care for minors, marking the most significant actions yet by the Trump administration against transgender Americans.
The proposed rules would block federal Medicaid and Medicare funding for hospitals that provide puberty blockers, hormone therapy, or surgical interventions to transgender children. HHS Secretary Robert F. Kennedy Jr. called gender-affirming procedures “malpractice” and said they “rob children of their futures.”
If enacted, the proposals could affect nearly two dozen states where gender-affirming treatments are currently legal and covered by Medicaid. The rules conflict with guidance from major U.S. medical societies, and advocates warn they could put children’s lives at risk.
Rodrigo Heng-Lehtinen of The Trevor Project, a nonprofit supporting LGBTQ+ youth, said: “The multitude of efforts we are seeing from federal legislators to strip transgender and nonbinary youth of the health care they need is deeply troubling.”
Medicaid Coverage Under Threat
Currently, less than half of U.S. states cover gender-affirming care through Medicaid. At least 27 states have already restricted or banned the care. A recent Supreme Court decision upholding Tennessee’s ban suggests that most state restrictions are likely to remain.
The proposed rules are not final. They must undergo a lengthy public comment and rulemaking process before taking effect and are expected to face legal challenges. However, even the announcement alone may discourage hospitals and providers from offering care.
Hannah Edwards, executive director of Transforming Families in Minnesota, said private clinics may still provide care, but “that won’t be a solution for all kids seeking care.” Edwards, who has a transgender 15-year-old daughter, added: “The conversation that constantly happens for my family personally is: Where is our red line when we need to flee the country?”
Funding Cuts Could Affect Most U.S. Hospitals
Nearly all U.S. hospitals treat patients covered by Medicare and Medicaid. Losing federal funding for gender-affirming care could jeopardize care for many children. Similar restrictions would apply to the State Children’s Health Insurance Program for those under 19.
“This sets a very dangerous precedent for all areas of health care, if the government can cherry-pick one area of medicine to withhold necessary funding from entire groups of people,” said Dr. Scott Leibowitz of the World Professional Association for Transgender Health.
HHS also proposed removing gender dysphoria—a medical diagnosis for the distress some people feel when their gender identity does not match their assigned sex at birth—from the federal definition of disability.
Medical Experts and Advocates Push Back
Some administration officials, including Dr. Mehmet Oz of the Centers for Medicare and Medicaid Services, characterized transgender treatments as “a Band-Aid on a much deeper pathology” and suggested children with gender dysphoria are “confused, lost and need help.”
However, the majority of U.S. medical organizations, including the American Medical Association and the American Academy of Pediatrics, oppose the proposed restrictions. “Children and families will bear the consequences,” said Dr. Susan Kressly, president of the AAP.
Part of a Broader Effort to Limit Transgender Rights
These moves continue a series of actions by President Trump, his administration, and Republican lawmakers to restrict transgender rights. On his first day in office, Trump signed an executive order recognizing only two sexes—male and female—and has since barred transgender athletes from girls’ and women’s sports and limited federal spending on transition-related care.
In Congress, a bill criminalizing providers who offer transgender care to minors passed the House Wednesday and awaits Senate action. On Thursday, lawmakers also passed a bill to ban Medicaid coverage for gender-affirming care for children.
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