The US Department of Health and Human Services (HHS) unveiled a sweeping set of regulatory proposals on Thursday (Dec. 18) that would effectively block access to gender-affirming care for minors, the Trump administration’s most aggressive move yet to restrict medical care for transgender children.
The proposed actions would cut off Medicare and Medicaid funding to hospitals that provide puberty blockers, hormone therapy or surgery to minors and prohibit federal Medicaid dollars from being used to pay for such care. According to the federal announcement, the restrictions would also apply to the State Children’s Health Insurance Program (CHIP).
“This is not medicine, this is malpractice,” Health Secretary Robert F. Kennedy Jr. said. at a press conference. “Sex-refusal practices are robbing children of their future.”
Impact across states
More than half of US states already restrict or ban gender-affirming care for minors. But the federal proposals could significantly affect access in the nearly two dozen states where such treatment remains legal and, in some cases, covered by Medicaid using a combination of federal and state funds.
Almost all American 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 these payments would threaten the financial viability of most hospitals and could further discourage providers from offering gender-affirming care to children.
Many hospitals have already halted such care in anticipation of the federal action, according to health care advocates.
Further regulatory steps
Kennedy also announced that the HHS Office of Civil Rights will propose a rule excluding gender dysphoria from the federal definition of disability. In a related move, the Food and Drug Administration issued warning letters to a dozen companies that sell chest 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 mastectomy recovery. Companies receiving letters include GenderBender LLC of California and TomboyX of Seattle.
The rules are not final yet
The proposals are not legally binding at this stage. Federal agencies must complete a formal rulemaking process, which includes a period for public comment and revisions, before the rules go into effect. Legal challenges are generally expected.
Still, health experts warn that the proposed restrictions could have an immediate chilling effect on providers, especially given the financial risks associated with the loss of federal funding.
Opposition from the medical community
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, saying such treatment may be medically appropriate for some patients.
Care for gender-confirmed minors usually begins with a psychological evaluation and may include a social transition such as name or pronoun changes. Some patients later receive puberty blockers or hormone therapy. According to medical groups, surgery on minors is rare.
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The wider political context
The HHS action builds on a broader push by President Donald Trump and Republicans in Congress to roll back protections for transgender Americans.
On his first day in office, Trump signed an executive order stating that the federal government would recognize only two genders — male and female. He also signed orders aimed at reducing federal support for gender reassignment for those under 19 and banning transgender athletes from participating in girls’ and women’s sports.
On Wednesday, the House of Representatives approved a bill that would subject health care providers to prison for treating transgender patients under the age of 18.
The legal landscape
Currently, Medicaid programs in less than half of US states cover gender-affirming care. At least 27 states have enacted laws restricting or prohibiting such treatment. Federal judges struck down bans in Arkansas and Montana as unconstitutional, although legal battles in those states are ongoing.
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