Protecting Children by Harming Them: CMS Targets Trans Youth Care

On December 18, the Center for Medicare and Medicaid announced two proposed rules that would significantly impact access to gender-affirming care for youth enrolled in Medicaid.  These attacks are getting old—especially when they are under the guise of “protecting America’s children.” Both proposals were written in compliance with an executive order signed by President Trump in January 2025.

I spent my Saturday afternoon reading through the Federal Register to better understand these proposed rules. One of the first things that stood out to me is that both proposals use the term “sex-rejecting procedures” rather than gender-affirming care—a choice of language that reeks of the bigotry this administration has demonstrated all year.

The first proposal, (CMS-2451-P) would prohibit federal Medicaid and Children’s Health Insurance Program (CHIP) funding from being used for gender-affirming care for children under 18.  The second proposal, (CMS 3481-P) would prohibit hospitals that receive Medicare and Medicaid funding from providing these procedures to individuals under 18, making compliance a condition of their federal funding status.

While these proposals are just another attack from the Trump Administration, the Federal Register allows for public comment until February 17. After this public comment period closes, CMS must review and respond to the comments before issuing any final rules—a process that can take months. It is also highly likely that any final rule will be challenged in court.

What Does This Mean for Coloradans?

Colorado is one of the states with “shield laws” protecting access to gender-affirming care in minors.  However, if these rules are finalized, the state would have no authority to override Medicaid coverage restrictions. Because of this, it is recommended that minors and/or their parents check the status of available refills and work with their providers to develop a plan should these rules go into effect.

One Colorado, along with partners across the nation, is currently developing resources to help individuals better understand these proposals and to safely and effectively participate in the public comment process.

This past year has been exhausting for trans people. Keep fighting. Trans allies must keep fighting too. All of our voices matter in this fight.