Federal health officials under Donald Trump are taking aggressive steps to cut off funding for hospitals and doctors who provide gender affirming care to minors, using Medicare and Medicaid dollars as leverage in a move that could reshape equal access to care nationwide.
On Thursday, the Department of Health and Human Services unveiled a pair of proposed rules designed to financially penalize providers involved in pediatric gender affirming care. If finalized, the policies would force hospitals and medical professionals to choose between continuing those services or maintaining access to federal health funding, even in states where the care is legal.
One proposal would bar Medicaid programs at both the state and federal level from covering medical care for transgender patients under 18. It would also block reimbursements through the Children’s Health Insurance Program for gender affirming care for patients younger than 19. The second proposal takes a broader approach, cutting off all Medicare and Medicaid payments to hospitals that offer gender affirming care to minors in any capacity.
Because Medicare funding is essential for most hospitals to function, critics say the rule could make it nearly impossible for providers to continue offering care. While roughly 17 states currently allow Medicaid coverage for gender affirming procedures for minors, 27 states already ban or restrict the practice, creating a fragmented national landscape.
The proposed rules stem from an executive order signed by Trump that directs federal agencies to withhold funding from hospitals and medical schools and to block access to treatments such as surgeries, hormone therapy, and puberty blockers.
The timing is notable. Just one day earlier, House Republicans passed a health care package that would make providing gender affirming care to minors a criminal offense, punishable by fines or up to 10 years in prison. Lawmakers are also expected to vote on a separate bill led by Rep. Dan Crenshaw that would prohibit Medicaid coverage for this care for anyone under 18.
