The Trump administration on Thursday moved to restrict gender-affirming care for minors across the country, threatening to cut federal funding from hospitals that offer treatments like puberty blockers, hormone therapy or surgical procedures.
The proposed rules, if finalized, would affect nearly every hospital in the country, which rely on payment from the federal government to function — Medicare and Medicaid paid for half of inpatient hospital days for over 95% of facilities, according to the American Hospital Association.
Medicaid and the Children’s Health Insurance Program, which provide health insurance coverage for over 77 million adults and children, would also be barred from funding the treatments for people under ages 18 and 19, respectively.
“So-called gender-affirming care has inflicted lasting physical and psychological damage on vulnerable young people,” HHS Secretary Robert F. Kennedy Jr. said at a press conference Thursday. “This is not medicine, it is malpractice.”
The Trump administration will also direct the Food and Drug Administration to send warning letters to 12 manufacturers and retailers they say are conducting illegal marketing of breast binders to children. The breast binders, compression garments worn to flatten the appearance of breasts, could be subject to seizure if manufacturers don’t comply, Kennedy said.
Additionally, the HHS will direct the Office for Civil Rights to remove gender dysphoria as a qualified disability to ensure the proposed rules don’t violate nondiscrimination requirements. Previously, the Biden administration had moved to designate gender dysphoria as a disability under the Americans with Disabilities Act.
Curtailing access to gender-affirming care for minors has been a priority for the Trump administration. Days into his inauguration, President Donald Trump signed an executive order seeking to ban federal funding for youth gender-affirming medical treatments. He also directed the HHS to publish a literature report on gender-affirming care.
The report, issued in May, broadly disavows gender-affirming care treatments, including surgeries, hormone therapies and puberty blockers, and encourages providers to rely on behavorial therapy for minors experiencing gender dysphoria, or an incongruence between one’s assigned sex at birth and their gender identity.
The recommendations go against those issued by leading medical associations. The American Medical Association, American Psychological Association and the American Academy of Pediatrics have independently endorsed recommendations from World Professional Association for Transgender Health, a nonprofit organization dedicated to research on transgender healthcare, which recommends a social, psychological, behavioral and medical approach to treating gender dysphoria.
Trump has condemned the organization. On Thursday, Kennedy said, “The American Medical Association, the American Academy of Pediatrics peddled the lie that chemical and surgical sex-rejecting procedures could be good for children who suffer from gender dysphoria.”
The Trump administration argues gender-affirming care treatments don’t meet healthcare standards and expose children to “irreversible damage,” like altered brain development, infertility and diminished bone density.
On Thursday, Kennedy released a declaration stating “sex-rejecting procedures for children and adolescents are neither safe nor effective as a treatment modality for gender dysphoria, gender incongruence or other related disorders in minors, and therefore, fail to meet professional recognized standards of health care.”
The HHS pointed to those standards in its proposed rule, arguing the regulation sidesteps federal law requiring CMS not control the “practice of medicine” or the manner in which services are provided.
“...We believe that providing the [sex-rejecting procedures] for children is not healthcare and hence are not subsumed under the term of ‘the practice of medicine,’” one of the proposed rules states. “Therefore, the proposed rule would not regulate the practice of medicine.”
Susan J. Kressly, president of the the American Academy of Pediatrics called the proposed rules a “baseless intrusion into the patient-physician relationship” that focused “disproportionate attention on denying care to a small population of adolescents.”
“Allowing the government to determine which patient groups deserve care sets a dangerous precedent, and children and families will bear the consequences,” Kressly said in a statement.
The proposed regulations are the latest pressure on providers from the Trump administration, which has targeted hospitals and doctors who provide the care to minors.
In May, CMS Administrator Dr. Mehmet Oz demanded some hospitals turn over “complete financial data for all pediatric sex trait modifications” paid for by the government. Earlier in the year, the White House said it had tasked the Department of Justice with investigating providers and drug manufacturers that enable youth gender-affirming care.
In response, major health systems said they would pause gender-affirming care for minors, including Kaiser Permanente and the University of Pittsburgh Medical Center.
The Medicare and Medicaid proposed rules will solicit public comment for 60 days after being published in the federal register on Dec. 19.
