Medicaid Ends Funding for Youth Treatments
The Trump administration has announced that Medicaid and the Children’s Health Insurance Program will no longer use federal funds to pay for gender-affirming surgeries, puberty blockers or cross-sex hormones for transgender minors, with the policy set to take effect on 13 October.
The Centers for Medicare and Medicaid Services finalised a rule prohibiting federal financial participation for what the administration describes as sex-rejecting procedures for Medicaid beneficiaries under 18 and CHIP beneficiaries under 19. Mental health treatment for gender dysphoria remains covered. For those already receiving hormone therapy, federal funding will continue during a limited tapering period before being phased out. The change follows a directive from President Donald Trump to CMS Administrator Dr Mehmet Oz.
In a social media post, Trump said the government would not pay for “barbaric surgeries and practices” that cause unthinkable and irreversible harm to children’s bodies. HHS Secretary Robert F. Kennedy Jr stated that the federal government was ending taxpayer funding for interventions that carry serious risks and fail to meet the evidentiary standard children deserve. Oz added that the decision follows the science, protects children from potentially irreversible harm and saves taxpayer dollars.
The administration cites risks including infertility, impaired sexual function, reduced bone density and altered brain development, along with an HHS evidence review and the United Kingdom’s Cass Review, which highlighted weak supporting data and prompted restrictions in several European countries. CMS projects the policy will reduce combined Medicaid and CHIP spending by roughly $235 million over a decade, including about $138 million in federal funds.
Gender-affirming surgeries for minors are already rare; puberty blockers and hormones have been more commonly provided. At least 27 states have enacted their own bans on such care for those under 18, and many hospitals have scaled back services even where no ban exists.
The rule does not prohibit the procedures themselves. States may continue to cover them using only state funds, though federal matching dollars will no longer be available. It builds on earlier administration actions, including efforts to restrict hospital funding and other measures affecting transgender individuals.
Critics, including LGBTQ advocacy groups and major medical organisations such as the American Academy of Pediatrics, argue that gender-affirming care is evidence-based, reduces mental health risks and should remain a decision for families and physicians. Josh Rovenger of GLBTQ Legal Advocates and Defenders said the rule erects barriers between parents and the best medical decisions for their children and indicated it would face legal challenge. Human Rights Campaign President Kelley Robinson described the action as terrorising transgender youth and their families. The American Society of Plastic Surgeons has separately noted insufficient evidence that the benefits of certain surgeries on minors outweigh the risks.
Legal challenges are expected, consistent with litigation over previous related policies. Some earlier administration efforts have been blocked or limited by courts, while others have been allowed to proceed. Implementation will require state agencies to update their plans, and the outcome may ultimately depend on judicial review. Mental health supports continue uninterrupted, and providers may still offer the restricted services if financed independently of federal Medicaid and CHIP dollars.
