Health care for transgender young people would be banned almost everywhere under the new rules: vaccinations

Access to gender-affirming care for transgender youth will be drastically restricted by the Trump administration under new proposals from the Department of Health and Human Services.

NPR obtained the draft text from a proposed rule This would prohibit federal Medicaid reimbursement for medical care provided to transgender patients under 18 years of age. Additionally, reimbursement through the Children’s Health Insurance Program, or CHIP, is prohibited for patients under 19 years of age.

A additional proposed rule would go even further and block all Medicaid and Medicare funding for all services at hospitals that provide pediatric gender-affirming care.

The rules are being prepared for release in early November, according to an official at the Centers for Medicare and Medicaid Services. The employee asked NPR not to use their name because they feared professional retribution for speaking to the media without authorization. An HHS spokesperson did not respond to a request for comment on the planned timing of the proposed rules’ release.

A near ban in all states

Both proponents and opponents of transgender rights agree that the upcoming rules taken together could make access to pediatric gender-confirming care extremely difficult, if not impossible, across the country. Grooming is already prohibited 27 states.

“These rules would significantly intensify the Trump administration’s attack on transgender health care access,” he said Katie KeithDirector of the Center for Health Policy and Law at Georgetown University.

“I think it’s really, really important to note that nothing changes immediately,” she explains. “Those would be proposals that would be subject to public comment. It would take months for the Trump administration to issue a final rule, and then, if past is prologue, we would end up with litigation over the final rules.”

Management objectives

In his first days in office, President Trump signed one Implementing regulation declaring that the United States “will not finance, sponsor, promote, support, or encourage the so-called ‘transition’ of a child from one sex to the other.”

In the months since, HHS published a report critical of the research supporting access to this care. A federal suicide prevention lifeline specifically for transgender youth was Cancelledhow were Hundreds of millions US dollars to fund scientific research related to LGBTQ people. Federal health officials warned state Medicaid directors to proceed cautiously, and the Justice Department announced subpoenas some children’s hospitals and threatened providers with prosecution.

“I think these restrictions are very good,” says Terry Schilling about the upcoming rules. Schilling is president of the American Principles Projecta conservative interest group. “It will change the entire transgender industry and take away many sources of funding.”

He points to it an opinion poll from the spring that found 66% of the public opposed Medicaid coverage for this type of care for young people.

“They believe that if you want to have any type of sex change procedure, you have to pay for it,” Schilling says. “The American people are fully behind this effort.”

Dramatic new expansion of power

The proposal to make a hospital’s participation in Medicaid and Medicare contingent on discontinuing gender-affirming care for adolescents represents an “unprecedented” use of executive branch power to control what medical care is available in hospitals, Keith says.

“Because Medicare represents such a large portion of many hospitals’ revenues,” she explains, the rule would essentially force hospitals to stop providing gender care Programs for transgender youth. That would mean that all patients in these programs — regardless of whether they have Medicaid or private insurance — would lose access.

Keith says the federal government doesn’t typically apply this type of regulation in this way. She served on the Gender Policy Council in the Biden administration and worked on some “Conditions of Participation“Medicare and Medicaid regulations,” she says. “They’re so simple – it’s like having an emergency car.” [with] enough medicine to help a pregnant woman in crisis.”

Instead of health and safety standards, this proposal would direct hospitals to “completely stop offering a certain type of care to a certain group of patients,” she says.

Law professor Katie Eyer from Rutgers University questions whether such a regulation would withstand a legal challenge. “But if it were successful, I shudder to think what this government would do with such a tool in its hands,” she says. It could open the door for any White House to withhold all federal funding from hospitals to provide medical care that it does not approve of.

“It was clear that this was going to happen,” he says Lindsey DawsonDirector of LGBTQ Health Policy at KFF, a nonpartisan health research organization.

But the timing of the release has been a mystery for months. Notice of both proposed rules — but not the rules themselves — appeared in a government filing over the summer, and it was unclear why they hadn’t been made public yet, Dawson says.

“An obsessive focus”

The government’s efforts on transgender issues extend far beyond health policy and youth. The Federal Trade Commission recently organized a workshop “on unfair or deceptive trade practices in ‘gender-affirming care’ for minors.” The military was driven out Transgender soldiers. Universities have been told their federal funding is wrong quota about introducing anti-transgender policies on issues such as access to toilets.

Even the impending loss of SNAP funding is tied to Democrats’ support for “gender mutilation procedures,” a banner on the website says Ministry of Agriculture website.

“It’s endless,” Eyer says. “It really was an obsessive focus that was deployed throughout the administration.”

The warnings and canceled subsidies and more had a significant deterrent effect. In the states where nursing is still legal, many clinics and hospitals have completed their gender-equitable care programs. If these rules come into effect, the rest of the programs would likely follow suit.

“There are real people behind all of this,” says Eyer, who is also the mother of a transgender child. “People are very scared and suffering from this onslaught of attacks on the trans community.”

It is still legal, although access is becoming less and less

Gender-affirming care for adolescents — including the use of puberty-blocking drugs, hormones and, in rare cases, surgery — doesn’t actually violate federal law, Eyer notes. And despite the recent political pressureNo major US medical organization has changed their clinical guidelines supporting these treatments as appropriate and safe.

Approximately 3% of teenagers in the US identify as transgender or non-binary, although not all of them seek medical treatment related to their identity.

Especially in Utah, a state-commissioned analysis Most evidence recently came to the opposite conclusion as the Trump administration’s transgender report. Researchers at the University of Utah found that there was ample evidence of the benefits and safety of these treatments and wrote that policy restrictions on this care for adolescents “cannot be justified by the quantity or quality of medical science or concerns about possible future regret.”

The draft text of the proposed federal rule obtained by NPR does not mention the Utah analysis or cite the American Academy of Pediatrics’ guidelines also support Access to care.

In Eyer’s view, publishing these rules provides an opportunity to legally challenge them.

“It will succumb “arbitrary and capricious” review“And a court will probably look closely at the facts that actually underlie it,” she says. “This is actually better than what we had before, which was coercion without law.”

Diane Webber edited this story.