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The Senate parliamentarian blocked GOP efforts to ban gender-affirming care under Medicaid.
The nonpartisan arbiter of rules compliance rejected parts of the Republican so-called “Big Beautiful Bill.”
The Senate parliamentarian on Thursday struck down a Republican effort to ban federal funding for gender-affirming care through Medicaid and the Children’s Health Insurance Program, ruling the provision cannot remain in the GOP’s reconciliation package—a sweeping Trump-backed bill that LGBTQ+ advocates warn would devastate vulnerable communities.
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The provision, added late in the House process, sought to bar transgender people of all ages from accessing medically necessary transition-related care through Medicaid, ACA health plans, or the Children’s Health Insurance Program. Senate Parliamentarian Elizabeth MacDonough ruled the ban violated the Byrd Rule, which limits reconciliation bills to provisions with a clear budgetary impact.
According to Axios, MacDonough also rejected provisions targeting immigrants’ access to health care, limiting federal courts’ power to block unlawful policies, and repealing EPA rules on auto emissions. Other GOP priorities removed from the bill include a cap on Medicaid provider taxes and an effort to defund the Consumer Financial Protection Bureau. Still surviving, however, are deep cuts to the SNAP food assistance program and new limitations on state AI regulations—part of what Democrats are calling a sprawling rollback of public protections.
Illinois U.S. Sen. Dick Durban, the Democratic whip and ranking member of the Senate Judiciary Committee said that while the decision “dealt a blow to Republican attempts” to cut Medicaid, “the fight is not over."
David Stacy, the Human Rights Campaign’s vice president for government affairs, welcomed the ruling but said the broader bill still represents a direct assault on LGBTQ+ health. “The fact remains that this bill belongs in the trash,” he said. “It continues to include devastating cuts to health care programs – including Medicaid – that would disproportionately harm the LGBTQ+ community, all so the already rich can receive huge tax cuts.”
The HRC said the measure, along with cuts to SNAP and Planned Parenthood funding, amounts to one of the most sweeping federal attacks on LGBTQ+ people in modern history. “These lawmakers have abandoned their constituents,” HRC President Kelley Robinson previously said in a statement, vowing to mobilize in key swing districts. “They will hear from us.”
Related: New Trump Medicaid directive attacks trans people’s access to gender-affirming care
According to the group’s analysis, 21 percent of transgender people and 40 percent of people living with HIV rely on Medicaid. The GOP proposal could result in nearly 14 million people being kicked off the program, according to estimates from the Congressional Budget Office. It also includes stricter food assistance rules, slashes to ACA subsidies, and new immigration restrictions on Medicare and Medicaid access.
The Senate ruling arrives just weeks after the Centers for Medicare & Medicaid Services issued a “Dear State Medicaid Director” letter widely viewed as a backdoor attempt to help states eliminate coverage for gender-affirming care for minors. The letter cited sterilization rules historically unrelated to trans care, drawing fierce backlash from public health leaders.
While the parliamentarian’s ruling blocks several of the most extreme measures—including immigration-related health restrictions and state caps on Medicaid funding—Senate Republicans could attempt to rewrite the bill or override the decision by majority vote.
