Over the last two weeks, the Department of Health and Human Services (HHS) has made gender-affirming care for minors a matter of policy focus. Building on Executive Order No. 14187 from last January, the Department has proposed new regulations, released new guidance, and issued warnings aimed at limiting youth access to these services. These include a proposed new Condition of Participation (CoP) for hospitals receiving Medicare and Medicaid reimbursement.   

Secretary Kennedy issued a new declaration on behalf of HHS deeming “sex-rejecting procedures” inappropriate for minors’ care. Relying heavily on the HHS-commissioned report on pediatric gender dysphoria, Sec. Kennedy’s December declaration outlines how HHS will define these banned procedures, stating:  

“Sex-rejecting procedures for children and adolescents are neither safe nor effective as a treatment modality for gender dysphoria, gender incongruence, or other related disorders in minors, and therefore, fail to meet professional recognized standards of health care. For the purposes of this declaration, “sex-rejecting procedures” means pharmaceutical or surgical interventions, including puberty blockers, cross-sex hormones, and surgeries such as mastectomies, vaginoplasties, and other procedures, that attempt to align an individual’s physical appearance or body with an asserted identity that differs from the individual’s sex.” 

CMS has proposed a new CoP that would prohibit participating hospitals from providing gender affirming care to youth, regardless of the payer. Hospitals and other providers would be barred from providing pharmaceutical care like puberty blockers (medications that delay the onset of puberty) and hormone therapy for patients under 18. Surgical interventions would also be prohibited, although cases of such care for minor patients are more rare, according to the American Academy of Pediatrics. Even in states that elect to pay for gender-affirming care themselves through their Medicaid programs, hospitals would risk their federal funding should they violate this CoP. 

The CoP rule does make a narrow exception for treating individuals with medically verifiable sexual development disorders, treating complications caused or worsened by the performance of a sexual development-rejecting procedure, and for purposes other than attempting to “align an individual’s physical appearance or body with an asserted identity that differs from the individual’s sex.”  

The Trump Administration has also proposed prohibiting the use of federal Medicaid and CHIP funds from covering this care for youth under the age of 19. Regardless of the site of care, the proposal seeks to limit access to these services through controlling the funding—it does not prohibit providers from offering these services where medically appropriate. Programs would be able to reimburse for these same services when used for needs other than gender-affirming care. Under the proposal, states could use their state-only dollars to cover these services if desired. 

What’s next?  

The rules don’t become effective immediately and their language could change. CMS will be accepting comments on each proposal for 60 days, after which the finalized version of the regulation would be published. If finalized, many policy analysts expect the rules to face legal challenges. If you have questions, reach out to our team.