Proposed Rules Threaten Federal Funding for Trans Youth Care

By Tekla Taylor

The Trump administration continues to target trans people, and particularly trans youth, at an alarming rate. Trump and his allies constantly spread disinformation about our community to deny us our essential healthcare. The administration has given high ranking agency positions to people known for their extreme anti-trans and anti-science views. Now, they are using the powers of the federal government to attack life-saving care for young trans people. 

Trump’s Centers for Medicare and Medicaid Services proposed two new rules that, if allowed to go into effect in their current state, would severely restrict young trans people’s access to life-saving care and deny federal funding to any hospitals that provide gender-affirming care to minors. 

Nearly 37 million young people rely on federal programs for their healthcare, which includes thousands of trans youth. Decades of rigorous research show that gender-affirming care has significant positive mental health and psychosocial effects for  youth. These adolescents, who rely on federal programs for their health care, are now at enormous risk of having the government severely restrict the care they need.

What would these proposed rules do?

The first proposed rule targets both Medicaid and CHIP, the Children’s Health Insurance Program, by prohibiting the use of federal funds to cover medically necessary transition-related healthcare, including puberty-pausing medications, hormone therapy, and surgeries. This healthcare enables young people to live fully and healthily as their authentic selves. 

Combined, Medicaid and CHIP cover nearly 37 million young people up to age 19 across the country. This proposed rule would forbid Medicaid from covering trans healthcare for youth under 18 and CHIP from covering trans healthcare for young people under 19.

The second proposed rule seeks to bar any hospital participating in Medicare and Medicaid programs—which includes nearly all hospitals—from providing trans healthcare to young people under 18. This means that if the rule is adopted, any hospital that continues to provide gender affirming care to youth would have its federal funding stripped away. This would severely impact hospitals across the country and restrict the ability of trans youth to continue relying on these hospitals for their healthcare.

Importantly, hospitals rely on federal funding to care for all their patients—not just transgender young people. 44% of all hospital funding comes from the federal government.

Why are these rules so dangerous?

Healthcare standards should help, not harm. CMS already has health and safety standards called “conditions of participation” that hospitals must meet to participate in Medicare and Medicaid programs. The federal government has never used these standards as a weapon to stop licensed medical providers from providing care to a specific group of people—in this case, trans people. These standards are supposed to ensure hospitals and clinics provide the best care, not force them to deny care to people in need. 

The proposed rules are unscientific. This administration constantly dismisses, contradicts, and misrepresents proven science and established medical consensus—from vaccines to reproductive care. With these proposed rules, CMS rejects decades of careful medical research showing trans healthcare for the youth who need it is safe, effective, and necessary. 

The proposed rules falsify our healthcare in an attempt to stop trans patients—and only trans patients—from accessing a wide range of medical treatments solely because they are trans. With these proposed regulations, it’s clear that these anti-trans extremists are trying to use government processes to distort medical research and deny care to people who need it.

These proposed rules also allow cisgender, or non-trans, youth to receive the exact same treatments that trans adolescents receive. Alarmingly, the proposed rules also contain exceptions that would permit nonconsensual procedures to be performed on intersex infants. 

Allowing these treatments for some youth and not others demonstrates that the goal of these policies is to enforce outdated and unscientific stereotypes of sex and gender. The Trump administration continues to deny the existence of trans people and cut many of the resources we need to live our lives.

These rules are unlawful. Under Section 1801 of the Social Security Act, CMS is actually not authorized to “exercise any supervision or control over the practice of medicine." That’s supposed to be left up to the states, as well as doctors and medical associations. 

To get around this, CMS baselessly and incoherently claims that providing affirming healthcare to transgender children “is not healthcare and hence [is] not subsumed under the term of ‘the practice of medicine.’ Therefore, the proposed rule would not regulate the practice of medicine.” In reality, age-appropriate medical care for trans youth has been best-practice medical care for over forty years.

While not a nationwide ban, these rules could cause nationwide harm. 

These proposed rules pose a very serious threat to the health and safety of trans people, but they are not a nationwide ban on care for trans youth. Even if the proposed regulations go into effect, medical care for trans youth will remain legal in states where this care is allowed by state law. However, this would still deny much-needed healthcare to far too many people and may place wider strains on public health infrastructure. 

Our government should be expanding access to affordable healthcare for all Americans,  not perpetuating an unequal system where a person’s ability to access lifesaving care depends on where they live. 

If finalized and allowed to take effect, either proposed rule would severely endanger the health and wellbeing of tens of thousands of trans adolescents. If a young person depends on federal health insurance, they will be unable to access the transition-related healthcare they need despite it remaining legal. 

Furthermore, it could force hospitals to make an impossible choice between participating in these federal programs and providing medically necessary, and lifesaving transition-related care.  

What can we do?

At this time, these proposed rules have not been finalized, and CMS is accepting public comments through February 17, 2026. Public comments are an important way for people across the country to tell the federal government what matters to us. It’s crucial to make our voices heard! Join us on February 9 for our Hands Off Our Healthcare Comment-A-Thon, where legal experts from A4TE’s Trans Health Project will explain the proposed rules and how to leave a public comment.  You’ll then have an opportunity to submit your own. Tell the Trump administration you say NO to restrictions on our health care!