The Centers for Medicare and Medicaid Services has issued a rule prohibiting federal Medicaid and Children's Health Insurance Program funds from covering what it describes as 'sex-rejecting procedures' for individuals under 18. The rule takes effect October 13 and permits states to continue funding such treatments with their own dollars, while leaving mental health services for transgender youths eligible for federal reimbursement.
CMS Rule Bars Federal Medicaid and CHIP Funds for Gender-Affirming Care for Minors
The Centers for Medicare and Medicaid Services has issued a rule prohibiting federal Medicaid and Children's Health Insurance Program funds from covering what it describes as 'sex-rejecting procedures' for individuals under 18. The rule takes effect October 13 and permits states to continue funding such treatments with their own dollars, while leaving mental health services for transgender youths eligible for federal reimbursement.
CMS Administrator Dr. Mehmet Oz stated in a press release that the restriction is intended to protect children, characterizing it as 'following the science, saving taxpayer dollars, and, most importantly, protecting children from potentially irreversible harm.' Treatments that remain restricted from federal funding include hormone therapies, puberty blockers, and certain surgical procedures, though states retain the option to fund them independently.
President Trump posted on social media that he directed the decision, writing that the government would not pay for what he called 'barbaric surgeries and practices' resulting in 'unthinkable and irreversible harm' to minors. Health and Human Services Secretary Robert Kennedy Jr. said in a press statement that the interventions 'carry serious risks and can cause irreversible harm' and that the federal government would no longer use Medicaid and CHIP dollars to fund 'procedures that fail to meet the evidentiary standard our children deserve.'
The total spending by both Medicaid and CHIP on gender-affirming care in 2023 was $31 million, according to the article. The number of individuals relying on those programs specifically for such care is not publicly available.
Since the rule was first proposed in December 2025, more than 35,000 public comments were submitted criticizing it.
According to policy nonprofit KFF, at least 27 states have enacted legislation restricting minors' access to gender-affirming care, and at least 50 percent of transgender youths ages 13 to 17 live in those states.
The American Society of Plastic Surgeons published a statement in February advising its members against performing gender-related surgeries before age 19, citing 'insufficient evidence' that benefits outweigh risks. The American Medical Association, which had previously opposed restrictions on gender-related care, also said surgical interventions should generally be deferred until patients reach adulthood.
Researchers in 2024 identified 108 cases of any gender-affirming surgery among minors between 2018 and 2021, representing 0.04 percent of all transgender youth in the United States.
The Medicaid rule is among several administration actions affecting transgender individuals. The Department of Veterans Affairs has phased out care for transgender veterans, workplace protections for transgender federal employees were removed, and the Equal Employment Opportunity Commission overturned guidance on workplace harassment based on gender identity. The administration also imposed new restrictions on military service by transgender people and issued an executive order stating that the federal government recognizes only two 'immutable sexes: male and female.'
- The source does not specify which precise procedures are classified as 'sex-rejecting' under the rule's text.
- The source does not detail the legal basis or statutory authority CMS invoked to issue the rule.
- The source does not quantify how many minors currently receive gender-affirming care through Medicaid or CHIP specifically.
- The source does not describe what process, if any, states must follow to use their own funds for the restricted treatments.
- The source does not include responses from medical associations such as the American Academy of Pediatrics or the Endocrine Society, which have published clinical guidelines on gender-affirming care for minors.
- The source does not detail the timeline or expected venues for the anticipated legal challenges.