School, college and other closings for Monday

MPR News helps you turn down the noise and build shared understanding. Turn up your support for this public resource and keep trusted journalism accessible to all. 

Turn Up Your Support

Access to gender-affirming care for transgender youth will be dramatically restricted by the Trump administration under new proposals by the Department of Health and Human Services.

 that would prohibit federal Medicaid reimbursement for medical care provided to transgender patients younger than age 18. It also prohibits reimbursement through the Children's Health Insurance Program or CHIP for patients under age 19.

 would go even further, blocking all Medicaid and Medicare funding for any services at hospitals that provide pediatric gender-affirming care.

The rules are being prepared for public release in early November, according to an employee at the Centers for Medicare and Medicaid Services. The employee asked that NPR not use their name because they fear professional retribution for speaking to the media without authorization. An HHS spokesperson did not respond to a request for comment about the planned timing of the proposed rules' release.

Both supporters and opponents of transgender rights agree that, taken together, the forthcoming rules could make access to pediatric gender-affirming care across the country extremely difficult, if not impossible. The care is already banned in 

"These rules would be a significant escalation in the Trump administration's attack on access to transgender health care," says 

, director of the Center for Health Policy and the Law at Georgetown University.

"I think it's really, really important to note that nothing is changing immediately," she explains. "These would be proposals that would go out for public comment, it would take months for the Trump administration to issue a final rule, and then, if past is prologue, we would see litigation over whatever the final rules are."

In his first days in office, President Trump signed an 

 declaring that the United States "will not fund, sponsor, promote, assist, or support the so-called 'transition' of a child from one sex to another."

 critical of the research that supports access to this care. A federal suicide prevention lifeline specifically for transgender youth 

 of dollars in scientific research funding related to LGBTQ people. Federal health officials warned 

 to tread carefully, and the Department of Justice 

"I think these restrictions are very good," says Terry Schilling of the forthcoming rules. Schilling is president of the 

, a conservative advocacy group. "It's going to change the entire transgender industry, and it's going to take away a lot of their funding streams."

 from the spring, which found 66 percent of the public opposes Medicaid coverage for this type of care for young people.

"They believe that if you want to get some type of sex-trait modification procedure, you should have to pay for it," Schilling says. "The American people are fully behind this effort."

The proposal to condition a hospital's participation in Medicaid and Medicare on halting gender-affirming care for youth represents an "unprecedented" use of the executive branch's power to control what medical care is available in hospitals, says Keith.

"Because Medicare is such a significant portion of many hospitals' revenue," she explains, the rule would essentially force hospitals to end their gender care

programs for transgender youth. That would mean all of those programs' patients — whether they have Medicaid or private insurance — would lose access.

This is not how the federal government normally uses this type of rule, Keith says. She served in the Biden administration on the Gender Policy Council, and worked on some "

" regulations for Medicare and Medicaid, she says. "They're so basic — it's like, you have to have a crash cart [with] enough medicine to help a pregnant woman in crisis."

Instead of health and safety standards, this proposal would instruct hospitals "to stop offering a certain type of care completely to a certain patient population," she says.

 of Rutgers University questions whether such a rule would survive a court challenge. "But if it were successful, I shudder to think what this administration would do with such a tool in their hands," she says. It could open the door for any White House to withhold all federal funding from hospitals over the provision of medical care that it disfavors.

"The writing has been on the wall that this has been coming," says 

, director of LGBTQ Health Policy at KFF, a nonpartisan health research organization.

Yet the timing of the release has been a mystery for months. Notice of both proposed rules — though not the rules themselves — appeared on a government register over the summer, and it's been unclear why they have yet to be released, Dawson says.

The administration's efforts on transgender issues stretch far beyond health policy and beyond youth. The Federal Trade Commission recently 

 "on unfair or deceptive trade practices in 'gender-affirming care' for minors." The military forced out 

. Universities have been told their federal funding is 

 on adopting anti-transgender policies on issues like bathroom access.

Even the impending lapse in funding for food assistance, or SNAP, is linked to Democratic support for "gender mutilation procedures," according to a banner on the 

"It's endless," says Eyer. "It really has been an obsessive focus that's been deployed across the administration."

The warning letters and cancelled grants and more have had a significant chilling effect. In the states where the care is still legal, 

 have ended their programs for gender-affirming care. If these rules were to take effect, the remaining programs would likely follow suit.

"There are real people behind all this," says Eyer, who is also the parent of a transgender child. "People are really scared and suffering as a result of this onslaught of attacks on the trans community."

Walz moves to protect those seeking gender-affirming care

A year after Minnesota became a trans refuge, ‘transplants’ make themselves at home

How a Supreme Court ruling on gender-affirming care could impact Minnesotans

It's still legal, although access is shrinking

Gender-affirming care for youth — including puberty blocking medications, hormones, and rarely, surgery — does not actually violate federal law, Eyer notes. And, despite recent 

, no major U.S. medical organization has altered their clinical guidance that supports these treatments as appropriate and safe.

 identify as transgender or nonbinary, although not all of them seek medical treatment related to their identity.

 of the evidence recently came to the opposite conclusion as the Trump administration's transgender report. University of Utah researchers found that there was ample evidence of benefits and safety for these treatments, and wrote that policy restrictions on this care for youth "cannot be justified based on the quantity or quality of medical science findings or concerns about potential regret in the future."

The draft text of the proposed federal rule obtained by NPR does not mention the Utah analysis, nor does it cite the American Academy of Pediatrics, whose guidelines 

In Eyer's view, the public release of these rules will offer the opportunity for them to be legally challenged.

, and a court will presumably take a close look at the factual basis that actually underlies it," she says. "That is actually preferable to what we've had up until now, which is coercion without law."

Health

Homepage

Selena Simmons-Duffin

Author

The White House plans to bar hospitals that treat transgender children and youth from getting any Medicare and Medicaid payments. The move would affect trans youth who have private insurance, too.

Trump pushes an end to medical care for transgender youth nationally

Go Deeper.

Like this?

News you can use in your inbox