On Dec. 18, the Department of Health and Human Services (HHS) announced a multipronged plan to curtail the availability of gender-affirming care for minors, carrying out President Donald Trump’s January 28 executive order that directed the department to end the practice on children.
In conjunction with this plan, the Centers for Medicare & Medicaid Services (CMS) released two notices of proposed rulemaking, which are open to public comment for 60 days. One proposed rule would amend the conditions of participation (PDF) to bar hospitals that perform “sex-rejecting” procedures on children under age 18 from participation in the Medicare and Medicaid programs. A second proposed rule (PDF) would prohibit federal Medicaid funding for “sex-rejecting care” provided to patients under the age of 18 and prohibit reimbursement through the Children’s Health Insurance Program for such care among patients under the age of 19. “Sex-rejecting care” is defined in the rules to include puberty-blocking drugs, hormone therapies, and surgeries. As the announcement notes, “Currently, 27 states do not provide Medicaid coverage of sex-rejecting procedures on children.”
Along with these rules, the HHS announced several other actions to restrict gender-affirming medical care for minors. The Food and Drug Administration announced that it will issue warning letters to 12 manufacturers of breast binders (tight garments used to flatten chest appearance) for “illegal marketing” of the products to children as a treatment for gender dysphoria. The HHS Office of Civil Rights announced it will exclude “gender dysphoria” from the definition of “disability” under Section 504 of the Rehabilitation Act of 1973. The Assistant Secretary for Health and Head of the U.S. Public Health Service Commissioned Corps signed a public health message (PDF) to inform health care providers, families, and policymakers that current evidence does not support claims that puberty blockers, “cross-sex hormones,” and surgeries are safe and effective treatments for pediatric gender dysphoria.
During its press conference, HHS leaders referenced a recent study published by the department, Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices.