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The U.S. Centers for Medicare and Medicaid Services (CMS) will soon introduce a proposal to ban hospitals that offer gender-affirming medical care to trans youth from receiving Medicare or Medicaid reimbursements, a senior Trump administration official told the conservative magazine National Review this week.
The proposed CMS rule will be entitled “Hospital Condition of Participation: Prohibiting Sex Trait Modifications for Children,” per the Review, although CMS officials had not yet posted such an announcement at time of writing. If enacted, the official said the rule would “end sex-trait modifications for minors nationally” by blocking Medicaid and Medicare reimbursements to any hospitals that provide care including puberty blockers and hormone replacement therapy to minors.
“[H]ospitals cannot participate in Medicare of Medicaid if they provide sex trait modification services to minors, full stop,” the administration official told the Review. The official also falsely claimed that gender-affirming care is “child mutilation,” rhetoric the administration has adopted to bolster its campaign to outlaw trans medicine. Trump’s January anti-trans executive order falsely characterized gender-affirming care as equivalent to female genital mutilation, while a propagandistic “fact sheet” released by the administration in April referred to gender-affirming care as “mutilation” 16 separate times. Last month, while announcing subpoenas to “nearly 20” healthcare providers, Attorney General Pam Bondi similarly accused doctors of having “mutilated children in the service of a warped ideology” by offering gender-affirming care.
If the official’s characterization of the proposed rule is accurate, it would be the Trump administration’s latest attempt — and one of its largest — to effectively ban gender-affirming care for trans youth. CMS and the Department of Health and Human Services (HHS) introduced another such proposal in March preventing individual and small-group health plans from including gender-affirming care as an “essential health benefit” under the Affordable Care Act (ACA), a rule that was finalized in June. (That rule also debuted the administration’s phrase “sex trait modification” as a euphemism for gender-affirming care, though the phrase was not defined.)
The GOP already attempted to ban Medicaid and Medicare reimbursements for gender-affirming care earlier this year through Trump’s so-called “On Big Beautiful Bill.” Early versions of the wide-ranging spending bill included a provision to ban such reimbursements, but it was eventually stripped out under the procedural “Byrd rule,” which prevents “extraneous” material from inclusion in budget reconciliation bills. The final reconciliation law still orders approximately $990 billion in gross budget cuts to Medicaid over the next 10 years, which will disproportionately affect LGBTQ+ people across the U.S.
More than a dozen state attorneys general filed a lawsuit against the Trump administration last week, challenging Trump’s anti-trans executive orders and what they called the government’s campaign of “pressure” against healthcare providers to create “an atmosphere of fear and intimidation” surrounding trans care. Hospitals around the country, as well as major care network Kaiser Permanente, have folded to that pressure over the past several months, agreeing to halt various forms of gender-affirming care — including in some cases for teens under 19 years old, who are legally considered adults in most U.S. states. (Separately, a federal judge issued a preliminary injunction last week blocking provisions of the reconciliation bill that prevent Planned Parenthood from receiving federal funds.) 25 states and the District of Columbia specifically cover gender-affirming care in their Medicaid packages, according to the Williams Institute.
“[T]he administration’s actions put providers in an impossible position: either comply with unlawful federal threats or violate state laws that require nondiscriminatory access to medical care,” New York Attorney General Letitia James’ office said in a statement last week.
