The Trump administration has issued a rule that prevents Medicaid from funding gender-affirming care for people under 18 and bars CHIP funding for those under 19, while preserving coverage for mental health services. The change blocks hormone therapies and most gender-affirming surgeries for minors, allows current hormone patients up to six more months of coverage, and appears to take immediate effect for puberty blockers and surgeries. The rule — backed by Health Secretary Robert F. Kennedy Jr. and CMS chief Mehmet Oz — drew more than 35,000 public comments and is expected to face legal challenges. Major medical organizations oppose the restriction and cite evidence linking gender-affirming care to improved mental-health outcomes for transgender youth.
Federal Rule Blocks Medicaid, CHIP Funding For Gender-Affirming Care For Minors
The Biden-era policy rollback announced by the Trump administration bars two federal programs that serve low-income Americans from funding most gender-affirming medical care for transgender youth. Under the new rule, Medicaid may not cover gender-affirming care for people under 18, and the Children’s Health Insurance Program (CHIP) is barred from covering such care for those under 19.
What the Rule Does
The regulation explicitly prohibits Medicaid and CHIP from funding pharmaceutical interventions such as hormone therapies and from covering gender-affirming surgeries for minors — procedures that are already rare and typically allowed only in extremely limited circumstances. Mental health services for transgender youth will continue to be covered under both programs.
Implementation And Exceptions
The rule appears to take immediate effect for coverage of puberty blockers and surgeries. Current Medicaid and CHIP patients who are already receiving hormone therapy are permitted to continue receiving coverage for up to six more months.
Supporters, Critics And Context
The change was announced after a public comment period that drew more than 35,000 responses. Administration officials, including President Donald Trump and Health Secretary Robert F. Kennedy Jr., as well as Centers for Medicare and Medicaid Services administrator Mehmet Oz, framed the move as protecting children and taxpayers. President Trump posted on Truth Social that Medicaid "will NO LONGER fund gender transition surgeries and hormones for minors" and described such interventions as harmful.
"The federal government is putting up barriers between parents and their ability to make the best medical decisions for their children," said Josh Rovenger, legal director at GLBTQ Legal Advocates & Defenders. "That should be chilling to every American."
Major medical organizations — including the American Academy of Pediatrics, the American Medical Association, the American Academy of Child and Adolescent Psychiatry, and the American Counseling Association — maintain that gender-affirming care is clinically appropriate for many young people with gender dysphoria. Researchers, including a 2022 peer-reviewed study from The Trevor Project, have linked gender-affirming hormone therapy with lower rates of depression, suicidal ideation, and suicide attempts among transgender and nonbinary youth.
The policy is expected to prompt legal challenges and has been criticized by LGBTQ+ advocacy groups. The Federal Trade Commission has also sued the World Professional Association for Transgender Health (WPATH) earlier this year, alleging deceptive claims about gender-affirming care for minors.
Why It Matters
The rule shifts federal funding policy for some of the nation’s largest public insurance programs and will directly affect access to medically recommended treatments for low-income transgender youth. Advocates warn the change could increase barriers to care and exacerbate mental health risks for affected young people; supporters argue it protects children from unproven or risky interventions.
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