Trump administration finalizes rule to end federal support for gender-affirming care

Move blocking funds through Medicaid and Chip to make it harder for vulnerable children to get healthcare, experts say

The Trump administration finalized a rule on Tuesday to end gender-affirming care through Medicaid and the Children’s Health Insurance Program (Chip), a move that will make it harder for vulnerable children to access healthcare and that eschews evidence to advance an anti-transgender ideology, opponents say.

The rule is set to take effect on 13 October – but legal challenges could delay or block it entirely.

Ending federal funding for children receiving gender-affirming care was first proposed in December, and it received nearly 35,000 comments, about 90% of them opposing the change, said Ma’ayan Anafi, senior counsel for health equity and justice at the National Women’s Law Center (NWLC).

The NWLC outlined concerns in one such comment , including pages of evidence on the benefits and safety of gender-affirming care.

“This is an incredibly dangerous rule,” said Anafi. While advocates have prepared for the policy since it was proposed late last year, it is still “incredibly distressing for our community”, they added.

The US Department of Health and Human Services (HHS) pointed in a press release to international reviews of the medical evidence such as the Cass Review in the United Kingdom, which has been widely criticized for skewing the evidence, but it did not include the more recent landmark report from the Netherlands finding that gender-affirming care is safe and effective, and should be widely supported.

The new HHS policy was “not about following the science. It’s about promoting this administration’s anti-transgender agenda,” Anafi said. “This stigma is really the primary function of this rule.”

It could also add fuel to the rhetoric increasingly being used in state-level bans and restrictions on care.

Also in December, HHS proposed a rule that would prevent any health systems receiving Medicaid and Medicare payments – which is the vast majority of health systems in the US – from providing gender-affirming care, but there have been no further announcements on that proposal.

At the same time, HHS immediately began using a little-known statute to refer health systems to prosecutors for offering gender-affirming care, which led to dozens of major providers abruptly ending care across the country. A federal judge blocked the administration from pursuing this prosecution in an April decision that chastised the HHS secretary, Robert F Kennedy Jr, for his “wanton disregard” for the law that “causes very real harm to very real people”, deeming his actions “unsafe”.

On 3 August, federal employees and their families filed a class-action lawsuit against the Trump administration for ending insurance coverage for gender-affirming care.

Legal challenges to the new rule could delay or block the policy entirely, Anafi said: “A lot of courts have recognized that these actions are based on prejudice and they’re not based on evidence – they’re actually contrary to the evidence.”

If it does take effect, there are other options for providing the care.