The Trump administration is moving to broadly curtail gender transition care for young people, proposing Thursday to eject medical providers from major federal health insurance programs if they provide services including hormone therapy or procedures such as mastectomies to children and teenagers.
The rules, if finalized, could result in a wide-scale contraction of the availability of transition services for children. As the single largest payer for health care in the United States, the federal government has enormous sway over hospitals, clinics and doctors’ offices, which rely heavily on reimbursement from Medicare and Medicaid. The proposed regulations would prevent those providers from receiving funding for any type of medical visit if they also offer youth transition care.
“We are done with junk science driven by ideological pursuits, not the well-being of children,” said Health Secretary Robert F. Kennedy Jr., who said at a news conference that he signed a declaration Thursday saying that “sex-rejecting procedures pose medical dangers of lasting harm on children who receive these interventions.”
The new regulations, which still need to be finalized, would also ban Medicaid and the Children’s Health Insurance Program from paying for transition care for those under 18 and 19, respectively.
The American Civil Liberties Union said it will sue over the new regulations if they’re finalized. And Democratic state officials issued statements hinting at possible legal clashes.
New York Attorney General Letitia James (D) vowed to “use every tool at my disposal to fight this proposal and protect transgender Americans and their families.”
The Food and Drug Administration is also sending warning letters to manufacturers of chest binders, which are used to flatten breast tissue, alleging they are illegally marketing them to children as a treatment for gender dysphoria.
Assistant Secretary for Health Brian Christine, who before his appointment called for transgender youth to undergo “corrective care” instead of transitioning, also signed a public health message saying that “current evidence does not support claims that puberty blockers, cross-sex hormones and surgeries are effective treatments for pediatric gender dysphoria,” Kennedy said.
Erecting walls around transition treatments for children is a top priority for the Trump administration amid an international reckoning over how to respond to a sharp rise in young people seeking gender transition care.
Officials characterized gender transition procedures as “experimental” on youth, with Centers for Medicare and Medicaid Services Administrator Mehmet Oz saying they are used to treat children like “lab mice.”
Associations representing pediatricians and pediatric hospitals condemned the Medicaid restrictions. Matthew Cook, CEO of the Children’s Hospital Association, said in a statement that “federal government regulations should not get in the way of parents and families accessing care.” The American Academy of Pediatrics called the rules “a baseless intrusion into the patient-physician relationship.”
Kennedy condemned both the AAP, which HHS is stripping of federal grants, and the American Medical Association by name at Thursday’s news conference, saying they “peddled a lie” that transition care was good for children. The AMA did not immediately respond to a request for comment.
LGBTQ+ advocates also criticized the administration’s announcement. “These proposed actions would put Donald Trump and RFK Jr. in those doctor’s offices, ripping health care decisions from the hands of families,” Kelley Robinson, president of the Human Rights Campaign, said in a statement.
HHS officials frequently invoke parental rights when discussing childhood vaccines, and the agency is investigating at least one school over a complaint that it had a student vaccinated without their parents’ consent. Yet when it comes to transition care, Oz said the government needs to step in because parents have been “tricked” into getting harmful care for their children.
“We believe the system’s been gamed so badly that I can’t even trust the process,” Oz said in a brief interview, adding that his son, who recently finished medical school, was taught to separate children from parents for conversations about gender transition.
Trump issued an executive order in January declaring that the U.S. “will not fund, sponsor, promote, assist, or support the so-called ‘transition’ of a child from one sex to another,” and directed health agencies to enact the restrictions on Medicare and Medicaid funding.
Last month, the Department of Health and Human Services released a final report on transition care for children, largely written by critics of such treatment, that concluded that more evidence is needed about the long-term effects and urged counseling before other interventions.
Leading medical associations defend the availability of such care and say questions about long-term unknowns overlook the consequences of a child’s distress as their body develops in a way that does not align with their gender identity.
Conservatives and some former transition care providers have charged that young people questioning their gender identity are being given sometimes-irreversible interventions too quickly, with providers taking children and teenagers at their word without first conducting a fuller exploration of the source of their distress. While detransitioning among adults is historically rare, those who have shared their stories have been influential in shaping policies to curtail the care.
About half the states have banned gender transition care for minors. The Supreme Court affirmed the constitutionality of those laws this year when it upheld a Tennessee law banning young people from using hormones and puberty blockers for gender transition.
The GOP-led House on Wednesday passed a measure along party lines that would allow health providers to be charged with a felony and sentenced to up to 10 years in prison if they treat people under age 18 with puberty blockers, hormones or surgeries. The bill is likely to stall in the Senate. Republicans tried earlier this year to ban pediatric gender transition care within Trump’s tax and spending legislation, but that provision was stripped out under Senate rules governing budget reconciliation bills.
It’s unclear how much Medicaid and CHIP — which are run by states and partly funded by the federal government — pay for pediatric transition care. Reporters found that Mississippi’s Medicaid program spent a tiny fraction of its funds on services connected with gender dysphoria, but the agency couldn’t specify precise amounts or how much of the care was provided to youths.
Jenna Portnoy contributed to this report.
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