On January 28, President Trump signed an executive order that aims to restrict access to gender-affirming health care for transgender minors. A new report from the Williams Institute at UCLA School of Law provides an analysis of the order. It also examines how the order could impact transgender youth.
The Williams Institute estimates that there are 300,000 transgender youth ages 13 to 17 in the United States. Of these, over 180,000 live in states that currently support access to gender-affirming care. Some of these youth may now face barriers to receiving care based on the order. The 110,000 transgender youth who live in states that currently restrict or limit access to care could face additional challenges.
The executive order aims to prohibit federal support for gender-affirming care for minors—defined as youth under age 19—through various means, including disregarding established standards of care for transgender youth, stopping agency and program activities that support access to gender-affirming care, and ceasing federal research and education grants to medical institutions that provide gender-affirming care.
“This executive order ignores decades of scientific research that established the safety and effectiveness of gender-affirming care for youth whose doctors prescribe it,” said lead author Elana Redfield, Federal Policy Director at the Williams Institute. “It also disregards numerous studies that show gender-affirming hormone therapy and surgeries for youth are actually very rare which suggests that the treatments are being tailored to the youth who need them most.”
In addition to transgender minors living in states that don’t ban the care, the executive order will primarily impact the following youth:
- Transgender people who are age 18. The executive order limits access to care for transgender people who are under age 19. Most state-level bans restrict care for minors aged 17 and younger and do not impact access to care for adults. The order will likely impact access to care for some 18-year-old transgender people who are currently able to access care even in states with bans.
- Transgender dependents of military service members. Congress has enacted legislation that prohibits funding under TRICARE for gender-affirming treatments for the minor dependents of service members. The president’s executive order also extends this prohibition to youth aged 18.
- Youth enrolled in Medicaid, Medicare, and other health assistance programs. The Williams Institute estimates that 276,000 transgender adults are enrolled in Medicaid nationally, though it is not possible to estimate the number of transgender youth enrolled due to limitations in existing data. Coverage for gender-affirming care under Medicaid currently varies from state to state. A federal ban on coverage for gender-affirming care in these plans could result in a loss of care for transgender youth who rely on these benefit plans.