The Trump administration has withdrawn a proposal that would have threatened Medicare and Medicaid funding for hospitals providing gender-affirming care to transgender youth, marking a significant victory for LGBTQ+ advocates and major medical organizations.
The proposal, introduced by the Centers for Medicare and Medicaid Services (CMS) in December under Administrator Mehmet Oz, would have barred hospitals from receiving federal Medicare and Medicaid funding if they continued offering gender-affirming care to transgender patients under 18. Because Medicare and Medicaid account for nearly half of most hospitals’ revenue, critics warned the policy would have effectively eliminate access to care nationwide.
According to documents obtained by NPR, the administration has now backed away from the proposal following months of public opposition. More than 30,000 comments were submitted during the rulemaking process, including objections from the American Medical Association and the Children’s Hospital Association, both of which support gender-affirming care as the medically accepted treatment for gender dysphoria.
Former Department of Health and Human Services General Counsel Sam Bagenstos called the decision “a victory” for transgender people and those defending their rights, though he cautioned it does not signal a broader shift in the administration’s approach to LGBTQ+ issues.
CMS declined to discuss the withdrawal, stating it does not comment on future rulemaking. The agency reiterated that the administration opposes what it called “ideologically driven surgical interventions on vulnerable children,” despite the fact that gender-affirming surgery for minors is rare and typically limited to older teens who meet strict medical guidelines.
Legal experts also questioned whether the proposal exceeded the federal government’s authority. Bagenstos argued the Medicare Act does not allow the federal government to use Medicare and Medicaid funding to dictate how states regulate the practice of medicine, describing the proposal as an unprecedented attempt to impose ideological restrictions on healthcare.
Major medical organizations continue to support gender-affirming care for transgender youth, citing research showing it can significantly improve mental health and reduce rates of depression and suicidal ideation for those experiencing gender dysphoria.
For many transgender people, access to that care is life-changing. Alexa, a transgender woman from Indiana, told NPR that hormone therapy helped ease years of severe gender dysphoria and suicidal thoughts.
“The hormones didn’t change my brain, they changed my body to finally match my brain,” she says. “Gender affirming health care literally saved my life.”
While the administration’s broader efforts targeting transgender healthcare continue, advocates say the decision to abandon the funding proposal preserves access to medically necessary care for transgender youth and prevents hospitals from being forced to choose between federal funding and treating their patients.
