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Trump officials said Tuesday that Medicaid would no longer cover gender transition surgery, puberty blockers or hormones for minors, as President Donald Trump escalates his administration's crackdown on transgender medical care ahead of the midterm elections.
The prohibition also applies to people 18 or younger covered by the Children's Health Insurance Program (CHIP), according to a final rule issued by the Centers for Medicare and Medicaid Services. The rule is expected to take effect on Oct. 13, though Medicaid and CHIP beneficiaries who are actively receiving hormone therapy will be able to continue to receive coverage for up to six additional months as part of a "tapering-off period," officials said.
Medicaid and CHIP benefits will continue to cover mental health treatments for transgender youths, according to the notice.
It was not immediately clear how many patients would be affected by the administration's new rules. The administration estimated its rule would save approximately $25 million a year currently spent on transgender health care, mostly for hormone treatments. That's a small fraction of the more than $615 billion the federal government spends annually on Medicaid. More than 35 million children are covered through Medicaid and CHIP, according to federal officials.
"By cutting off federal funds for these sex-rejecting procedures, we're following the science, saving taxpayer dollars, and, most importantly, protecting children from potentially irreversible harm so they can truly flourish," CMS Administrator Mehmet Oz said in a statement.
States could continue to pay for the procedures, but without federal matching funds.
The move was swiftly hailed by conservatives, who said the administration was following through on Trump's pledges to crack down on transition surgery and other transgender health care. The president campaigned in 2024 on promises to reverse Biden-era policies that aimed to promote transgender rights and offered additional protections for gender transition surgeries.
"President Trump is bringing the nation back from the brink of an ideological madness that has corrupted the practice of medicine and maimed and sterilized countless innocent children," said Roger Severino, vice president of economics and domestic policy at the Heritage Foundation, a conservative think tank.
Some Democrats and advocates for LGBTQ+ minors immediately criticized the Trump administration's rule, warning that it would put some transgender youths at risk.
"Every young person is entitled to the health care that they, their parents, and their medical providers agree that they need, without politicians interfering with these important and highly personal decisions," Kelley Robinson, president of the Human Rights Campaign, said in a statement.
Katie Keith, who served as deputy director of the White House Gender Policy Council during the Biden administration, said she was worried about low-income youths who are covered through Medicaid and CHIP, which are safety-net programs. She also noted that Tuesday's move comes as the Trump administration has targeted Medicaid funding for cuts, which could force leaders of liberal-leaning states to make difficult choices about what procedures to help fund.
"These are really low-income families, and so if the federal dollars fall away and a state can't fill that gap or can't fill it quickly enough, you're going to have families go without care," Keith said. "That could have devastating consequences and disruptions to ongoing care."
Democrats have reassessed their support for some transgender policies, such as transgender youth participation in sports, amid polling that some of the policies are not popular.
The American Medical Association, the American Academy of Pediatrics and other medical associations have endorsed gender transition care as "medically necessary," but the Trump administration has moved aggressively to limit such care since the president's first day in office. Trump frequently celebrates Republicans' efforts to restrict gender transition care for minors and limit transgender athletes' participation in women's sports, viewing the issue as a political winner.
On Truth Social on Tuesday evening, Trump said he directed Oz to implement the new rule. He linked his announcement to November's midterm elections.
"While the Dumocrat Party wants your kids to be able to chop off their reproductive organs before they are old enough to vote, President Donald J. Trump (ME!) and the Republican Party say that is ABSURD, and we will protect America's children," Trump wrote. "Please remember this when you are casting your vote in the Midterm Elections in November."
Many of the Trump administration's efforts to restrict care for transgender youths have been challenged in court. The Human Rights Campaign Foundation last week sued the administration over its prohibition of health insurance coverage for transition-related care for federal employees and their family members.
The administration has also moved to eject hospitals from major federal health insurance programs if they provide services including hormone therapy or procedures such as mastectomies to minors. A legal challenge over that policy is pending.
The Supreme Court last year allowed the administration's policy to stop letting people self-identify their gender on passports while litigation over the policy played out in lower courts. Earlier this year, it upheld state bans on transgender athletes playing on girls' and women's sports teams.