The Trump administration is taking action to cut off all Medicare and Medicaid funding for hospitals and practitioners that perform gender transition medical treatments on minors.
The Centers for Medicare and Medicaid Services proposed new rules on Thursday barring hospitals from performing what the administration calls “sex-rejecting procedures on children” under age 18 from receiving federal Medicare and Medicaid funding.
Nearly all hospitals in the United States accept Medicare and Medicaid funding, so the new rules would tie the hands of providers who have been supplying puberty blockers and cross-sex hormones to minors, as well as those who perform gender transition surgeries, including mastectomies, phalloplasty, or vaginoplasty.
The CMS, headed by Dr. Mehmet Oz, also published a rule to prohibit federal Medicaid and Children’s Health Insurance Program dollars from funding gender transition treatments for people under 19.
The new proposed rules follow through on an executive order from President Donald Trump in January that instructed agencies to restrict access to gender transition medical treatments for minors.
Health and Human Services Secretary Robert F. Kennedy Jr. said at a Thursday press event that the new rules prevent children and adolescents struggling with gender dysphoria from being pressured “into decisions they cannot fully understand and that they can never reverse.”
“Hospitals rake in millions of dollars by convincing boys and girls that a lifetime of off-label prescriptions for estrogen and testosterone blockers, chest reconstruction, surgeries, and more are the only way to achieve true happiness and belonging in life,” Kennedy said. “It’s wrong.”
Oz said puberty blockers reduce an adolescent’s bone density, alter brain development, and can disrupt sexual function well into adulthood. Cross-sex hormones also cause infertility, loss of sexual function, and cardiovascular problems.
Oz also said that CMS spent $30 million in Medicaid payments in 2023 for gender transition medicine for minors.
“Our estimate is over 10 years it would have been $250 million, at least,” Oz said.
Restricting hospital funding for transgender medical services for minors has been a long-anticipated move in the Trump administration’s broader strategy against gender transitions for children and adolescents.
However, critics of the policy have argued that such rules would represent an unprecedented expansion of executive branch authority over medical care, regulating the types of procedures rather than the standards at which they should be performed.
Katie Keith, a former member of the Gender Policy Council under the Biden administration, told NPR in October that the federal government typically uses “conditions of participation” rules for more innocuous or routine issues, such as having sufficient on-hand medical equipment for emergencies.
Department of Health and Human Services officials did not answer reporter questions regarding the anticipated legal strategy for the likely multiple lawsuits against the new rules. However, one official said it is both “common sense and the duty” of HHS to ensure that hospitals receiving federal funding do not perform “these irreversible procedures on minors.”
The new rules are subject to a 60-day public comment period before they can take effect.
The CMS announcement comes along with several other actions from HHS to discourage healthcare providers and families from pursuing gender transition treatment for children and adolescents.
Kennedy signed a declaration Thursday, finding that gender transition procedures for minors “do not meet professionally recognized standards of care,” based upon a peer-reviewed report from HHS published in November on the safety and efficacy of hormonal and surgical treatments for minors with gender dysphoria.
“So-called ‘gender-affirming’ care has inflicted lasting physical and psychological damage on vulnerable young people,” Kennedy said Thursday. “This is not medicine; it is malpractice.”
Kennedy said his declaration is a “clear directive to providers to follow the science and the overwhelming body of evidence that these procedures hurt, not help, children.”
Insurance claims data cited by HHS indicate that nearly 14,000 minors received some form of gender transition medical treatment between 2019 and 2023.
The University of California, Los Angeles, estimates that 2.8 million people in the U.S. over age 13 identify as transgender. About 724,000 are between the ages of 13 and 17, or roughly 3% of the youth population.
Assistant Secretary for Health Brian Christine, who was involved in drafting the November HHS report, also signed a public health message to inform healthcare providers, policymakers, and families that current evidence does not support the use of puberty blockers, cross-sex hormones, or surgeries for treating gender dysphoria in minors.
The Food and Drug Administration also issued warning letters to 12 manufacturers of breast binders on Thursday, saying that they are illegally marketing their products to treat gender dysphoria in minors.
Breast binders are used to help women recover from mastectomy surgeries, such as following breast cancer. But they are also marketed to biologically female adolescents who identify as male.
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Breast or chest binding for extended periods of time can have short-term effects on breathing and longer-term side effects of pain, as well as musculoskeletal and neurological symptoms.
Kennedy also announced that the HHS Office of Civil Rights would be undoing Biden administration amendments to the Americans with Disabilities Act that interpreted gender dysphoria as a disability. “Our proposed rule will reassure recipients of HHS funding that policies preventing or limiting sex-rejecting procedures do not violate disability non-discrimination requirements,” Kennedy said.
