Issue
The proposed rule follows a January 2025 executive order from President Trump directing federal agencies to withdraw funding and support from health care institutions that provide gender-affirming care to transgender youth under age 19. In response, the Centers for Medicare & Medicaid Services (CMS) has proposed adding a new Condition of Participation requiring hospitals that receive Medicare, Medicaid, or CHIP funding to stop providing hormonal or surgical care for the treatment of gender dysphoria in transgender minors.
Impact
An estimated 3.3% of U.S. youth ages 13 to 17—approximately 724,000 teenagers—identify as transgender. Because most U.S. hospitals participate in Medicare and Medicaid, the proposed rule could affect a substantial portion of these youth. For example, about half of transgender youth (360,800) live in states without statewide bans on gender-affirming care, and most of those (285,300) reside in states with “shield” laws designed to protect access. If finalized, hospitals across the nation—even in states without bans—would risk losing federal funding if they continue providing this care. This has the potential to disrupt access to effective treatments for gender dysphoria in hospital settings nationwide.
Summary
Scholars write that CMS’s proposed condition departs from evidence-based standards. They explain that the evidence CMS relies on to justify the rule is flawed and potentially biased, and they provide a more comprehensive review of research demonstrating the benefits of gender-affirming care for transgender youth. They also note that CMS fails to consider the harms of denying such care, including the broader consequences for transgender adults, disruptions to health care systems, and the chilling effect on future research on transgender health and well-being.
Additionally, scholars explore concerns about federalism raised by the rule—the traditional balance of powers between states and the federal government. They assert that imposing the proposed condition on all Medicare- and Medicaid-participating hospitals overrides state authority, compels hospitals to depart from established standards of care, and usurps powers traditionally reserved to the states to regulate medical practice.