HHS on Dec. 18 proposed new rules that would end federal funding to any hospital that provides gender transition care to minors.
Federal officials said CMS will start a rulemaking process to bar hospitals from providing gender-affirming care — including puberty blockers, hormone therapy and gender-related surgeries — to children under 18. The proposed regulations call for ending Medicare and Medicaid payments for all medical services to hospitals that provide gender-affirming care to youth.
“Nearly all U.S. hospitals participate in Medicare and Medicaid and this action is designed to ensure that the U.S. government will not be in business with organizations that intentionally or unintentionally inflict permanent harm on children,” HHS said in a news release.
Seven notes:
1. CMS is also proposing a rule to ban Medicaid and the Children’s Health Insurance Program from covering gender-affirming care for children under 18 and 19, respectively. The proposed rules are subject to a 60-day public comment period and are likely to be challenged in court, according to The New York Times.
2. HHS’ Office for Civil Rights has also proposed a revision to the definitions of “disability” under Section 504 of the Rehabilitation Act of 1973 to exclude “gender dysphoria.”
The change, “would reassure recipients of HHS funding that policies preventing or limiting sex-rejecting procedures do not violate Section 504’s disability nondiscrimination requirements,” the agency said.
3. Additionally, the FDA plans to send warning letters to 12 manufacturers and retailers for the “illegal marketing of breast binders to children for the purposes of treating gender dysphoria.” The warning letters will formally notify companies of regulatory violations and outline corrective actions, according to federal officials.
4. The proposed regulations align with an executive order President Donald Trump signed in January directing federal agencies to reassess policies and ensure that federal dollars do not support the provision of gender-affirming care to minors. The order, titled “Protecting Children from Chemical and Surgical Mutilation,” specifically directed HHS to explore regulatory changes that would exclude coverage of gender-affirming care under Medicare, Medicaid and the ACA.
5. Major medical associations including the American Medical Association and American Academy of Pediatrics support transition-related care for minors with gender dysphoria, a diagnosis that refers to the distress individuals experience from incongruence between their birth sex and gender identity.
6. The AAP condemned HHS’ proposed rule and is calling on the agency to reverse course.
“Unprecedented actions and harmful rhetoric taking place today by HHS leaders mark a concerning departure from the longstanding principle that healthcare policy should be grounded in scientific evidence, clinical expertise and the needs of children and their families,” the group said in a statement.
The AAP said the move threatens the integrity of the patient-physician relationship and warned that allowing the government to dictate which patient groups deserve care “sets a dangerous precedent.”
“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,” the group said.
7. More than 20 hospitals have already scaled back or ended their gender-affirming care programs for minors in response to broader pressure from the Trump administration this year. Read more about federal officials’ actions to curb access to gender-affirming care and how hospitals have responded here.
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