Responsive and Affirming Care Under Attack: A Call to Defend Health Justice for All

At CSSP, our health justice work strives to ensure that all children, youth, and families have access to options for high-quality, culturally-affirming services that support their health and wellbeing. We have a collective responsibility to ensure that every person has access to care that is responsive to their needs and promotes their health.  

For children and youth, supporting healthy development is essential, and gender-affirming care is a critical component of supporting developmental health. Gender-affirming care, at its most basic, is health care that recognizes and affirms someone’s gender identity. Ranging from social affirmation and therapy to medical interventions, it benefits people of all gender identities. For example, for cisgender people, this may include procedures like breast reduction surgery for boys to alleviate the social and mental health challenges of unwanted breasts. In fact 97% of all breast reduction surgeries on minors are performed on cisgender boys. Gender-affirming care has been recognized by major medical organizations—including the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Endocrine Society—as medically necessary. It has been shown to decrease the risk of depression and suicide for young people, and for many, gender-affirming care is what allows them to be healthy, engage in school and relationships, and feel safe. 

Yet in recent years, access to gender-affirming care has been undermined, not by changes in medical best practice, but due to political ideology. In December, the Department of Health and Human Services and the Center for Medicare & Medicaid Services (CMS) proposed rules that would functionally eliminate access to certain medical procedures and treatments only when used to support the health of transgender, non-binary, and gender diverse youth. Through a pair of proposed rules, the Administration seeks to eliminate coverage while simultaneously threatening the viability of hospitals and medical providers that provide this care.  

One rule would prohibit the use of federal Medicaid or CHIP funds to cover affirming medical treatments, putting care out of reach of low-income youth and families. The second rule proposes to strip hospitals of critical Medicare and Medicaid funds if those hospitals provide affirming care for minors—even when those procedures are funded through non-federal dollars. If adopted, the rule would place hospitals in an impossible bind: if hospitals continue to provide this care then they would be forced to significantly reduce the services they provide for the entire community and risk potential closure, if they stop providing gender-affirming care they will be acting outside of the medical best interest of children and youth, contributing to real and long-term harm.  

Together, these rules would impose an effective near-total ban on gender-affirming care. By attacking both health coverage and hospital operations, the Administration intends to create a significant shortage of providers willing and able to offer this care – even for families who can afford the cost. 

This latest attack follows the federal government’s ongoing assault on gender-affirming care, including Executive Orders to restrict affirming care for minors, threats to prosecute health providers, and the cancellation of existing grants and contracts supporting research and services promoting the health and well-being of youth who identify as LGBTQIA+.  

Policymakers claim that their actions are motivated by concern for children and youth, but these efforts are fueled by transphobia. This is evident in the hostility repeatedly shown toward transgender people. Senior administration officials have publicly disputed the basic premise that gender identity can differ from sex assigned at birth, have equated supporting transgender children with child abuse, and have sought to erase transgender people from history. In states that have banned gender-affirming care, legislators have openly used inflammatory and disdainful language against transgender, non-binary, and gender diverse youth.  

The discriminatory intent is clear. These bans specifically target affirming care for transgender, non-binary, and gender diverse youth while preserving it for cisgender youth. When a doctor advises the use of medication for a young person, and the drug is determined to be safe, all youth should have access. As an example, Medicaid should cover puberty blockers for both a cisgender youth experiencing precocious puberty and to support alignment of a transgender youth’s gender identity and sex. 

States can play a critical role in promoting the health and wellbeing of transgender, non-binary, and gender diverse youth by codifying protections for gender-affirming care for minors in statute and passing non-discrimination policies. Additionally, states, hospitals, providers, and families can work together to identify strategies to mitigate the harm caused to children and youth and develop supportive strategies to promote every child’s health and wellbeing.   

Every child, young person, and adult deserves to lead a healthy and happy life: free from fear, with access to the supports and care they need, surrounded by an affirming community, and with the autonomy to make their own choices.