Trump’s New Medicaid Rule Targets Gender-Affirming Care for Minors

The rule put forth by the Centers for Medicare and Medicaid Services (CMS) bars Medicaid from paying for what it calls “sex-rejecting procedures for children under 18.” Also restricted is funding from Children's Health Insurance Program (CHIP), a state and federal program that provides low-cost coverage to families that make too much money to qualify for Medicaid.

"The federal government will no longer use Medicaid and CHIP dollars to fund procedures that fail to meet the evidentiary standard our children deserve," Health and Human Services Secretary Robert F. Kennedy Jr. said in a press statement about the rule.

Under the new rule, which goes into effect Oct. 13, states can still fund certain treatments—including hormone therapies, puberty blockers, and some surgical procedures—but federal dollars will be restricted. Mental health services for transgender youths will still be funded through Medicaid.

The cuts will heavily impact the low-income families who rely on Medicaid to access certain treatments that they believe to be necessary for a young person’s well-being.

“There will be legal challenges to this rule,” Shannon Minter, legal director for the National Center for LGBTQ Rights tells TIME. “I believe it will be deemed to be unlawful when it's challenged.”

This is not the first push to limit gender-affirming care access to minors. According to policy nonprofit KFF, at least 27 states have enacted legislation to that effect, and at least 50% of transgender youths ages 13 to 17 live in those states.

What is gender-affirming care—and who uses it?

Gender-affirming care refers to a wide range of social, psychological, behavioural, or medical interventions used to help affirm a person's gender identity. These therapies can be particularly useful for transgender people who experience gender dysphoria, which the American Psychiatric Association defines as “distress caused by the discrepancy between one’s experienced/expressed gender and one’s assigned gender and/or primary or secondary sex characteristics.”

According to Minter, there is a misconception over how severe a minor’s dysphoria must be in order to get access to gender affirming care before they turn 18.

“In order to qualify for this care, a young person has to be experiencing very severe, prolonged distress,” Minter says. “I think maybe some people have the misconception that this care is being provided to kids just who are gender nonconforming or who are just identifying as transgender, but that is not the case.”

The number of people who rely on Medicaid and CHIP for gender-affirming care is not publicly available, but in 2023 the spending from both programs on those services totaled $31 million. 

Why the new Medicaid rule is contested

Trump wrote about the ruling on social media Tuesday, saying that he directed CMS Administrator Dr. Mehmet Oz to enact the new restrictions. 

“We are not going to pay for our innocent children to undergo these barbaric surgeries and practices, which result in unthinkable and irreversible harm to their young bodies,” the post said.

Oz said in a press release that the rule will protect children and is “following the science, saving taxpayer dollars, and, most importantly, protecting children from potentially irreversible harm so they can truly flourish.” TIME has reached out to the CMS for additional comment.

LGBTQ+ advocates say the change is dangerous for minors who rely on gender-affirming care. 

“It is terribly harmful,” Minter says. 

Since the rule was first proposed in December 2025, more than 35,000 public comments were submitted that critiqued it. That’s because it is an “unnecessary attempt to prevent transgender and nonbinary young people from accessing the best-practice health care they need to lead healthy and happy lives,” says Rodrigo Heng-Lehtinen, senior vice president of public engagement campaigns at the Trevor Project.

“The Trevor Project’s research shows that access to this care is associated with significantly lower rates of depression and suicide risk among transgender and nonbinary young people who receive it,” he said in a statement to TIME.

Supporters of Trump’s new rule point to medical associations like the American Society of Plastic Surgeons, which published a statement in February advising its members against performing any gender-related surgeries before age 19, saying there was “insufficient evidence” that the benefits outweigh risks. Soon after, the American Medical Association, which for many years opposed efforts to restrict gender-related care, also said surgical interventions generally should be deferred until patients reach adulthood.

Minter says conversations around surgeries are often a red herring, though, since they are very rare; hormone therapies are much more common.

“There are some limited surgeries for older adolescents, but it is not genital surgery,” he says. “It’s extremely rare.”

In 2024, researchers found just 108 cases of any gender-affirming surgery among minors between 2018 and 2021, accounting for 0.04% of all transgender youth in the U.S. 

Trump’s other policies affecting transgender people

The Medicaid restriction helps to fulfill Trump’s campaign vow to “stop” gender-affirming care for minors. It is the latest in a series of administration policies affecting transgender people of all ages.

Soon after returning to office in 2025, Trump signed an executive order to ban transgender women and girls from participating in women's sports at both K-12 schools and colleges. 

He also imposed new restrictions on military service by transgender people and signed an executive order saying that the federal government would only recognize two “immutable sexes: male and female.”

The Administration has made several other policy changes impacting the lives of transgender people. The Department of Veteran Affairs phased out care for transgender veterans, the Trump Administration removed workplace protections for transgender federal employees, and the Equal Employment Opportunity Commission overturned guidance on workplace harassment based on gender identity. 

“[The Trump Administration] thinks that the proper policy is to prevent and discourage people from being transgender. That’s not actually possible,” Minter says. “The policies they are implementing would just force transgender people to not transition, would force transgender people to just suppress and deny who they are and suffer.”

Reporting from Time contributed to this story.