Trump quietly bans federal health insurance from covering gender-affirming care

The Trump administration is quietly banning the federal government's largest health insurance provider from covering gender-affirming care even for adults.

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The U.S. Office of Personnel Management's Healthcare and Insurance division announced in an internal letter Friday from director D. Shane Stevens that "chemical and surgical modification of an individual's sex traits through medical interventions (to include 'gender transition' services) will no longer be covered under the FEHB or PSHB programs ... regardless of age."

The letter, posted on social media by independent journalist Ashley Renee and shared in a blog post by federal benefits law firm Ermer & Suter, said that the Federal Employees Health Benefits and Postal Service Health Benefits programs would be implementing the changes as of 2026.

The FEHB provides benefits to more than eight million federal employees, with the PSHB covering an additional two million postal workers. There are currently an estimated 14,000 federal employees who are transgender, according to the Williams Institute.

The denial of hormone therapies applies only to trans people who are using them to treat gender dysphoria, with the letter clarifying they must still be prescribed during IVF, for treating endometriosis or fibroids, and for cancer treatment or tumor growth prevention.

Exceptions will be available for patients "who are mid-treatment within a surgical and/or hormonal regimen for diagnosed gender dysphoria." Healthcare providers are tasked with determining who qualifies for the exception on a "case-by-case basis."

Counseling services for gender dysphoria will still be covered, with the letter stating that the "counseling services must be provided by a licensed mental health provider and may include those who provide faith-based counseling."

The American Medical Association, the American Psychiatric Association, the American Academy of Pediatrics, the American Academy of Child & Adolescent Psychiatry, the World Medical Association, and the World Health Organization all agree that gender-affirming care is evidence-based and medically necessary not just for adults, but minors as well.

“Everyone should have access to the health care they need – full stop. But this latest move by the Trump administration escalates the far-right’s war on trans people’s medically necessary health care – care that is backed by every major medical organization in the country and should be between providers and their patients” Kelley Robinson, president of the Human Rights Campaign, told The Advocate in a statement.

“Instituting blanket bans on people’s care drags us back decades and does not just impact federal employees, but plunges their spouses, dependents, and adult children into crisis too. First, this administration claims to know better than parents and cuts off younger folks’ access to care. Now they’re making their true aim clear as day: eliminating access to health care for transgender people of all ages. We’re going to fight this every single way we can.”