The Department of Health and Human Services will not finalize a proposed rule that would have blocked Medicare and Medicaid funding for hospitals providing pediatric gender-affirming care.
The Centers for Medicare and Medicaid Services said, "CMS does not comment on future rulemaking or speculate on potential actions. The Trump Administration rejects ideologically driven surgical interventions on vulnerable children."
The proposed rule would have applied to all gender-affirming care for people under 18; surgery is very rare among transgender people under age 18, and the rule mainly targeted therapy and medications for children.
HHS proposed the rule in December, received more than 30,000 public comments, and is abandoning the rule; the administration said it will not be finalized and will not take effect at least in the next year.
Sam Bagenstos, a Michigan Law professor who served as general counsel at HHS under the Biden administration, called the decision "a victory for people who are defending the rights and interests of trans people," and said the rule "violates the Medicare Act, which says that Medicare and Medicaid can't be used to control the practice of medicine within the state — states get to regulate the practice of medicine."
The American Medical Association and the Children's Hospital Association submitted comments urging the agency to rescind or withdraw the proposed rule, and major U.S. medical groups said that puberty blockers and sex hormones are safe and can be effective for transgender young people.
Gender-affirming care for youth is banned in 27 states after a flurry of laws passed over the last several years; in the remaining 23 states, many hospital clinics that offer gender-affirming care have continued to operate, while others have shuttered in the past year citing pressure from the Trump administration.
The administration has pursued other actions, including a separate rule that would bar federal Medicaid reimbursement for transgender pediatric patients and a declaration from Health Secretary Robert F. Kennedy Jr. that aimed to redefine the standard of care; the press release issued when those actions were unveiled in December is missing from the HHS website, as is the Kennedy declaration document.
The Department of Justice has issued administrative and criminal subpoenas to hospitals seeking full personal medical files for transgender youth and employment files for their medical providers, although many of those attempts have been blocked in court so far, and the administration has reached settlements with hospitals in Texas and Ohio that involved establishing "detransition" clinics.
The Medicaid rule is currently in the final stage of review and appears to be on track to take effect in the coming weeks; a coalition of Democratic-led states sued over the Kennedy declaration and succeeded in blocking it in federal court in Oregon, and the administration has not appealed that decision so far. An entry in the administration's unified agenda sets a final action date for the proposed Medicare and Medicaid conditions-of-participation rule as December 2028.