WASHINGTON — The U.S. Department of Health and Human Services on Thursday unveiled a series of regulatory actions designed to effectively ban gender-affirming care for minors, building on broader Trump administration restrictions on transgender Americans.
The sweeping proposals — the most significant moves this administration has taken so far to restrict the use of puberty blockers, hormone therapy and surgical interventions for transgender children — include cutting off federal Medicaid and Medicare funding from hospitals that provide gender-affirming care to children and prohibiting federal Medicaid dollars from being used to fund such procedures.
“This is not medicine, it is malpractice,” Health Secretary Robert F. Kennedy Jr. said of gender-affirming procedures on children in a news conference on Thursday. “Sex-rejecting procedures rob children of their futures.”
Kennedy also announced Thursday that the HHS Office of Civil Rights will propose a rule excluding gender dysphoria from the definition of a disability.
In a related move, the Food and Drug Administration issued warning letters to a dozen companies that market chest-binding vests and other equipment used by people with gender dysphoria. Manufacturers include GenderBender LLC of Carson, California and TomboyX of Seattle. The FDA letters state that chest binders can only be legally marketed for FDA-approved medical uses, such as recovery after mastectomy surgery.
Proposed rules would threaten youth gender-affirming care in states where it remains legal
Medicaid programs in slightly less than half of states currently cover gender-affirming care. At least 27 states have adopted laws restricting or banning the care. The Supreme Court’s recent decision upholding Tennessee’s ban means most other state laws are likely to remain in place.
Thursday’s announcements would imperil access in nearly two dozen states where drug treatments and surgical procedures remain legal and funded by Medicaid, which includes federal and state dollars.
The proposals announced by Kennedy and his deputies are not final or legally binding. The federal government must go through a lengthy rulemaking process, including periods of public comment and document rewrites, before the restrictions becoming permanent. They are also likely to face legal challenges.
But the proposed rules will likely further intimidate health care providers from offering gender-affirming care to children and many hospitals have already ceased such care in anticipation of federal action.
Nearly all U.S. hospitals participate in the Medicare and Medicaid programs, the federal government’s largest health plans that cover seniors, the disabled and low-income Americans. Losing access to those payments would imperil most U.S. hospitals and medical providers.
The same funding restrictions would apply to a smaller health program when it comes to care for people under the age of 19, the State Children’s Health Insurance Program, according to a federal notice posted Thursday morning.
Moves contradict advice from medical organizations and transgender advocates
Dr. Mehmet Oz, the administrator of the Centers for Medicare and Medicaid Services, on Thursday called transgender treatments “a Band-Aid on a much deeper pathology,” and suggested children with gender dysphoria are “confused, lost and need help.”
Polling shows many Americans agree with the administration’s view of the issue. An Associated Press-NORC Center for Public Affairs Research survey conducted earlier this year found that about half of U.S. adults approved of how Trump was handling transgender issues.
Chloe Cole, a conservative activist known for speaking about her gender-transition reversal, spoke at the news conference to express appreciation. She said cries for help from her and others in her situation, “have finally been heard.”
But the approach contradicts the recommendations of most major U.S. medical organizations, including the American Medical Association, which has urged states not to restrict care for gender dysphoria.
Advocates for transgender children strongly refuted the administration’s claims about gender-affirming care and said Thursday’s moves would put lives at risk.
“In an effort to strongarm hospitals into participating in the administration’s anti-LGBTQ agenda, the Trump Administration is forcing health care systems to choose between providing lifesaving care for LGBTQ+ young people and accepting crucial federal funding,” Dr. Jamila Perritt, a Washington-based OB/GYN and president and CEO of Physicians for Reproductive Health, said in a statement. “This is a lose-lose situation where lives are inevitably on the line. “
Rodrigo Heng-Lehtinen, senior vice president at The Trevor Project, a nonprofit suicide prevention organization for LBGTQ+ youth, called the changes a “one-size-fits-all mandate from the federal government” on a decision that should be between a doctor and patient.
“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,” he said.
Actions build on a larger effort to restrict transgender rights
The announcements build on a wave of actions President Trump, his administration and Republicans in Congress have taken to target the rights of transgender people nationwide.
On his first day in office, Trump signed an executive order that declared the federal government would recognize only two immutable sexes: male and female. He also has signed orders aimed at cutting off federal support for gender transitions for people under age 19 and barring transgender athletes from participating in girls’ and women’s sports.
On Wednesday, a bill that would open transgender health care providers to prison time if they treat people under the age of 18 passed the U.S. House and heads to the Senate. Another bill under consideration in the House on Thursday aims to ban Medicaid coverage for gender-affirming care for children.
Young people who persistently identify as a gender that differs from their sex assigned at birth are first evaluated by a team of professionals. Some may try a social transition, involving changing a hairstyle or pronouns. Some may later also receive hormone-blocking drugs that delay puberty, followed by testosterone or estrogen to bring about the desired physical changes in patients. Surgery is rare for minors.
Swenson, Perrone and Shastri write for the Associated Press. Shastri reported from Milwaukee. AP writer Geoff Mulvihill contributed to this report.
