Trump’s new Medicaid rule strips care from low-income families of transgender youth

The Trump administration has finalized a rule cutting off Medicaid and Children’s Health Insurance Program funding for gender-affirming medical care for transgender young people, turning the federal government’s financial leverage over two programs for low-income Americans into its latest tool against trans people’s access to healthcare.

The Centers for Medicare & Medicaid Services rule requires state Medicaid programs to stop paying for what the administration calls “sex-rejecting procedures” for people younger than 18 and imposes a corresponding prohibition on CHIP for those younger than 19. It is scheduled for publication in the Federal Register Thursday and takes effect 60 days later.

“Every young person is entitled to the health care that they, their parents, and their medical providers agree that they need, without politicians interfering with these important and highly personal decisions,” Human Rights Campaign President Kelley Robinson said in a statement to The Advocate criticizing the rule.

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“Rather than working to make healthcare more affordable and accessible, the Trump administration continues to obsess over the healthcare needs of trans youth,” Robinson said. “The Trump administration is terrorizing trans youth and their families with these kinds of actions, and it has to stop.”

Adrian Shanker, who served in the Biden administration at the Department of Health and Human Services, including as deputy assistant secretary for health policy and senior adviser on LGBTQI+ health equity, told The Advocate that the populations covered by Medicaid and CHIP make the rule particularly consequential.

“The entire purpose of Medicaid is that Medicaid is health insurance for low-income people. CHIP is health insurance for children from low-income families,” Shanker said. “These are the insurance systems that are designed for them.”

Medicaid is a federal and state partnership. In states that still cover gender-affirming care for minors, the federal government will no longer share the cost, leaving states to finance the care themselves if they want to preserve coverage. The final rule explicitly permits state-only funding and does not affect private insurance.

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“It was designed for cost sharing, but not to weaponize very specific types of care,” Shanker said of Medicaid.

The National Women’s Law Center said nearly 35,000 comments were submitted on the proposal and characterized them as overwhelmingly opposed. Ma’ayan Anafi, the group’s senior counsel for health equity and justice, accused Trump of “trying to score political points by endangering the health and wellbeing of trans youth.”

The administration is moving ahead with this Medicaid and CHIP rule after backing away from a separate, potentially broader approach. As The Advocate recently reported, HHS indicated it would not finalize a proposed conditions of participation rule that would have threatened hospitals’ ability to participate in Medicare and Medicaid if they provided specified gender-affirming care to minors — potentially reaching the care regardless of how an individual patient paid for it. CMS had proposed that measure in December as part of a package of restrictions.

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Tuesday’s rule takes a narrower route by controlling the public money rather than prohibiting hospitals from providing the care. The final regulation itself stresses that it is independent of the hospital proposal and does not prohibit providers from treating patients.

For current Medicaid and CHIP patients receiving hormone therapy, CMS will allow federal funding for up to six additional months. Puberty blockers and surgeries receive no such transition period.

“Trans youth did not ask to be the center of the culture of war,” Shanker said. “And they just deserve access to the healthcare that their body needs just like everyone else.”