Trump administration moves to cut off transgender care for children

The U.S. Department of Health and Human Services announced sweeping regulatory proposals on Thursday aimed at restricting access to gender-affirming care for transgender minors, representing the most significant action on this issue by the Trump administration to date.

The proposed measures would cut off federal Medicaid and Medicare funding from hospitals providing gender-affirming care to children and prohibit federal Medicaid dollars from covering such procedures. This would affect access in nearly two dozen states where these treatments remain legal and covered by Medicaid.

“This is not medicine, it is malpractice,” Health Secretary Robert F. Kennedy Jr. said during a news conference. “Sex-rejecting procedures rob children of their futures.”

The proposals contradict recommendations from major U.S. medical organizations, including the American Medical Association and American Academy of Pediatrics, which have urged states not to restrict transgender care. Advocates for transgender youth expressed alarm about the potential impact of these restrictions.

“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,” said Rodrigo Heng-Lehtinen of The Trevor Project, a nonprofit suicide prevention organization for LGBTQ+ youth.

Currently, Medicaid programs in slightly less than half of states cover gender-affirming care. At least 27 states have already adopted laws restricting or banning such care, a trend reinforced by the Supreme Court’s recent decision to uphold Tennessee’s ban.

The proposed rules are not yet final or legally binding. Officials must complete a lengthy rulemaking process, including periods for public comment, before restrictions become permanent. Legal challenges are anticipated.

Nevertheless, many healthcare providers are expected to further limit offering gender-affirming care to children in response to these proposals. Nearly all U.S. hospitals treat patients enrolled in Medicare and Medicaid, and losing access to these payments would create significant financial challenges for most medical providers.

“This sets a very dangerous precedent for all areas of health care, if the government can cherry-pick one area of medicine to use to withhold necessary funding from entire groups of people,” said Dr. Scott Leibowitz, a psychiatrist and board member for the World Professional Association for Transgender Health.

Hannah Edwards, executive director of Transforming Families, a support organization for families of transgender youth in Minnesota, noted that while some patients might still access care at private clinics that don’t participate in Medicaid and Medicare, this won’t be a solution for all children seeking treatment.

As the parent of a 15-year-old transgender daughter, Edwards expressed growing fear despite living in a state that has become a destination for families with transgender children. “The conversation that constantly happens for my family personally is: Where is our red line when we need to flee the country?” she said.

Kennedy also announced that the HHS Office of Civil Rights will propose a rule excluding gender dysphoria from the definition of a disability. Gender dysphoria is a formal medical diagnosis describing the distress felt when someone’s gender expression does not match their sex assigned at birth.

Dr. Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services, characterized transgender treatments as “a Band-Aid on a much deeper pathology” and suggested children with gender dysphoria are “confused, lost and need help.”

Public opinion appears divided on the issue. An Associated Press-NORC Center for Public Affairs Research survey conducted in May found that about half of U.S. adults approved of how Trump was handling transgender issues.

The American Academy of Pediatrics has called on HHS to reverse course. “These rules are a baseless intrusion into the patient-physician relationship. Patients, their families, and their physicians—not politicians or government officials—should be the ones to make decisions together about what care is best for them,” said Dr. Susan Kressly, AAP president.

Thursday’s announcements build on a series of actions President Trump and his administration have taken targeting the rights of transgender Americans. On his first day in office, Trump signed an executive order recognizing only two immutable sexes: male and female. He has also signed orders barring transgender athletes from participating in girls’ and women’s sports and cutting federal spending for transition-related care.

The House of Representatives recently passed legislation that would criminalize providing gender-affirming care to people under 18 and another bill intended to ban Medicaid coverage for such care for children. Both measures now await Senate consideration.