Trump’s Medicaid cuts are already hurting trans teens, New Hampshire families tell judge

Four transgender girls and their families in New Hampshire are asking a federal judge to pause a Trump administration rule that cuts federal Medicaid funding for most gender-affirming treatments for minors while their legal challenge proceeds.

The families argue that the federal government lacks the authority to impose the restriction. Their lawsuit is before U.S. District Judge Steven McAuliffe.

Four families filed the lawsuit against the federal government on October 1, arguing that the administration cannot use Medicaid restrictions to deny coverage for treatments doctors have determined are medically necessary.

The Centers for Medicare & Medicaid Services announced the rule in August, and it went into effect October 13. It prohibits federal Medicaid funding for certain treatments for patients under 18, including puberty blockers, hormone therapy, and gender confirmation surgeries. The families’ challenge concerns access to medications.

Related: Trump is targeting their daughters’ medical care. Four New Hampshire families are taking his HHS to court

At an October 30 hearing in Concord, attorneys representing the girls urged McAuliffe to issue a preliminary injunction, arguing that the policy is already harming their clients and could cause lasting damage, the New Hampshire Bulletin reported.

The legal team includes representatives from GLAD Law and the ACLU of New Hampshire.

One of the transgender plaintiffs, identified in court filings by the pseudonym Kylie Koe, is already experiencing the consequences of being unable to access puberty blockers, GLAD Law attorney Chris Erchull told the judge. Without the medication, changes associated with puberty are beginning to affect how her classmates perceive her, creating difficulties at school, Erchull said.

“Most of Kylie’s classmates only know her as a girl,” he told the court.

He stressed that puberty blockers cannot reverse physical changes that have already occurred. That makes timely access critical for the young people who need them, he argued.

The federal lawsuit also detailed the financial burden the policy would place on families like that of Logan Loe, a 15-year-old transgender girl who has been taking puberty-blocking medications covered by Medicaid for three years. Without coverage, her family would face treatment costs of roughly $70,000 a year, more than their annual household income, according to the complaint.

Related: New Hampshire governor signs law forcing schools to out transgender students

Much of the hearing, however, centered on a broader legal question: whether the federal government can exclude gender-affirming treatments from Medicaid coverage when Congress has mandated coverage of medically necessary care for children.

Erchull based much of his argument on the Early and Periodic Screening, Diagnostic and Treatment provision, known as EPSDT. The Medicaid requirement, established in 1967, mandates coverage of qualifying medically necessary services for eligible people under 21.

He argued that the provision leaves the administration without authority to categorically exclude treatments that qualified medical professionals consider necessary.

“Congress cannot have intended EPSDT to apply except when the president disagrees,” Erchull said.

He also maintained that decisions about medical necessity belong primarily to health care providers and state Medicaid agencies, rather than federal officials. Major medical organizations support gender-affirming care, he noted.

Related: New Hampshire Republican governor signs gender-affirming care ban into law

McAuliffe pushed back on the suggestion that federal officials have no role in determining which treatments qualify for coverage.

“The system isn’t at the whim of any healthcare provider that says this is medically necessary,” the judge said. “Someone has to make those decisions.”

While acknowledging that federal agencies cannot simply create laws, McAuliffe said he was struggling to accept Erchull’s interpretation of the agency’s limitations.

New Hampshire’s own restrictions on gender-affirming care for minors also became a significant part of the discussion.

In 2025, state lawmakers approved a ban on certain gender-affirming treatments for minors but included an exception for those who were already receiving care. Erchull argued that the four girls qualify for that exception.

Representing the federal government, Justice Department trial attorney Stephen Tagert argued that the administration’s policy should not be confused with a prohibition on gender-affirming treatment itself.

Related: 21 states sue over Trump’s attacks on gender-affirming care insurance coverage

“This is not about any sort of ban (on gender-affirming care),” Tagert said. “This is about whether the federal government pays for it.”

McAuliffe questioned that distinction, suggesting that removing Medicaid funding effectively prevents access to treatment.

“It’s an effective ban,” the judge said.

Following the hearing, Erchull told reporters that he believed McAuliffe recognized the immediate consequences the policy could have for the girls and their families. Tagert declined to comment to the Bulletin.