The Trump administration has announced that Medicaid and the state Children's Health Insurance Program (CHIP) will cease payments for gender-affirming surgeries and hormone treatments for transgender minors, a policy set to take effect on October 13.
President Trump stated on social media that he directed Dr. Mehmet Oz, the Centers for Medicare and Medicaid Services (CMS) administrator, to implement the change, describing the treatments as "barbaric surgeries and practices" causing "unthinkable and irreversible harm."
While Medicaid and CHIP will continue to cover mental health treatment for transgender minors, coverage for hormone treatments that assist in blocking puberty or inducing sex-related physical changes will be phased out for those already receiving them by April 2027.
It remains unclear how much taxpayer funding is currently allocated to gender-affirming treatments for transgender youth, as CMS did not provide figures in response to inquiries. The policy follows a series of actions by the administration impacting transgender individuals since Trump took office.
Many states have already implemented restrictions on gender-affirming care for individuals under 18, with at least 27 states having such bans. Even in states without explicit bans, numerous major hospitals have discontinued some of these treatments. Gender-affirming surgeries for minors are uncommon, while puberty blockers and hormone therapies are more frequently utilized.
Advocates for LGBTQ+ youth have criticized the decision. Josh Rovenger, legal director at GLBTQ Legal Advocates and Defenders, stated that the rule creates obstacles for parents seeking to make optimal medical decisions for their children and anticipates legal challenges. Kelley Robinson, president of Human Rights Campaign (HRC), condemned the administration's actions as an attempt to "terrorize trans youth and their families." HRC is currently engaged in litigation against the administration concerning efforts to exclude gender-affirming care coverage from federal employee benefit plans.
The American Medical Association and the majority of other prominent medical organizations endorse access to gender-affirming care. However, the American Society of Plastic Surgeons has previously indicated "insufficient evidence" regarding the benefits of chest, genital, and facial surgeries on minors with gender dysphoria compared to their associated risks.
This policy is part of a broader pattern of actions by the administration. Previous measures include proposals to cut Medicaid and Medicare funding for hospitals offering gender-affirming care to minors, barring transgender athletes from girls' and women's sports, and restricting the designation options on passports to male or female. A report issued by the administration last year recommended therapy exclusively for transgender youth, rather than comprehensive gender-affirming healthcare.
Several of these initiatives have faced legal scrutiny. The Supreme Court has allowed the administration's passport policy to proceed and permitted states to enforce sports bans. A lower court ruled against the administration's characterization of these treatments as unsafe and ineffective, while a challenge to the policy targeting hospitals remains pending.