Statement on Implementation of CMS Rule Prohibiting Federal Medicaid and CHIP Funding for Gender-Affirming Medication and Surgical Care

Today, the Centers for Medicare and Medicaid Services’ (CMS) final rule prohibiting the use of federal Medicaid and CHIP funding for gender-affirming medication¹ and surgical care for minors goes into effect. The implementation of this rule directly contradicts the purpose and goal of the Medicaid and CHIP programs to support the health of children living in low-income families by ensuring equitable access to care. This rule is one in a series of attacks that will cause incredible harm to transgender, nonbinary, and gender diverse youth.

Decades of research on adolescent development clearly indicate that effective and responsive health care requires respecting and affirming a young person’s identity, which is foundational to youth health, dignity, and wellbeing. For transgender, nonbinary, and gender diverse youth, research shows that gender-affirming care² promotes health and wellbeing, including by lowering experiences of depression and reducing the risk of suicide. Further, a recent survey highlights the danger of restricting access to gender-affirming care, finding that transgender and nonbinary youth who were unable to access hormones were nearly twice as likely to report a suicide attempt in the past year compared to those who were currently taking hormones.

We have a duty to ensure access to affirming health care. When a doctor advises the use of medication or a surgical procedure, and the drug or procedure is determined to be safe, all youth should have access. As of the writing of this statement, 21 Attorneys General and the Governor of Pennsylvania have sued the Administration to block implementation of this rule arguing that “CMS exceeded its authority by imposing a nationwide prohibition on federal reimbursement for health care that states have chosen to cover” and that “this unjustifiable rule will cause serious harm, especially to transgender youth and young adults.”

The health and wellbeing of young people cannot wait on the outcome of litigation. To support young people today, we need immediate action and to begin to advance new approaches to policy and practice moving forward. Already, policymakers in some states are taking action to protect and promote the health and wellbeing of transgender, nonbinary, and gender diverse youth. Governor Hochul of New York has committed to leveraging state Medicaid dollars to ensure all youth have access to the care they need, and Governor Lujan of New Mexico has committed state dollars to cover medications for gender-affirming care. These actions reflect meaningful steps to ensure all young people have access to the care they need at the state level. Federal policymakers must follow suit. Federal policymakers must codify in statute access to gender-affirming care for all young people, and CMS must repeal this rule. Not doing so, will cause incredible harm to the health and wellbeing of transgender, nonbinary, and gender diverse youth.

1. The final rule includes a limited tapering period: for enrollees who are receiving hormone therapy as of the effective date of the rule (October 13, 2026), federal funds can continue to cover the services “for a tapering period of up to 6 months.”
2. Gender-affirming care is health care that is responsive, affirming, and appropriate. It is not a single intervention, but a broad, individualized continuum of supports that may include social, mental health, and medical care.