The Trump administration announced dramatic plans Thursday to essentially end access to gender-affirming care for minors nationwide — even in states where it is legal.
Health and Human Services Secretary Robert F. Kennedy Jr. unveiled several rules that, if finalized, would prevent medical providers from receiving Medicaid and Medicare reimbursements if they offer transition care for youth, including prescribing puberty blockers or hormone therapy, or surgical procedures.
“We are done with junk science driven by ideological pursuits, not the well-being of children,” Kennedy said at a news conference, noting that he signed a declaration that “sex-rejecting treatments pose medical dangers” to children.
The new proposed regulations from the Centers for Medicare and Medicaid Services would prohibit hospitals from providing puberty blockers, hormone therapy and surgeries to minors as a condition of participation in Medicare and Medicaid, and prevent Medicaid and Children’s Health Insurance Program funding from being used for this care.
The proposed rules, which were first reported in October, are not final. They cannot go into effect until after a 60-day period of public comment, and they are likely to face legal challenges.
The American Civil Liberties Union said the proposals violate the Constitution, and the organization plans to sue the Trump administration if they are 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
During his first few weeks in office, President Donald Trump issued several executive orders targeting trans people, including an order barring federal funding from going to hospitals that provide gender-affirming care to minors and a declaration that there are “only two sexes, male and female.”
Last month, HHS released a final report on transition care written by skeptics of such care, determining that more evidence is needed about the long-term impacts. The report encouraged “psychotherapy” as a “noninvasive alternative,” departing from the standards and guidance of the majority of American medical associations.
Some physicians likened the agency’s push for “psychotherapy” as building a case for conversion therapy — a dangerous and long-discredited practice built on the belief that being gay or trans is an illness to be cured.
Over the summer, the Justice Department issued more than 20 subpoenas to doctors and clinics, requesting information on doctors and patients, including names, dates of birth and Social Security numbers. The news of the subpoenas had a chilling effect on clinics nationwide, and as a result, more than 20 have rolled back services for trans youth and young adults, including in states like California and New York, where there are not bans on such care.
Many LGBTQ+ advocates and Democratic officials condemned the proposed rules by HHS.
New York Attorney General Letitia James called the Trump 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 in a statement.
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 exacerbate an already restrictive 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 begin traveling 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 some 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.
