The Trump Administration announced Tuesday that it is implementing a rule to restrict federal funding of gender-affirming care for minors.
The rule put forth by the Centers for Medicare and Medicaid Services (CMS) bars Medicaid from paying for what it calls “sex-rejecting procedures for children under 18.” Also restricted is funding from Children's Health Insurance Program (CHIP), a state and federal program that provides low-cost coverage to families that make too much money to qualify for Medicaid.
"The federal government will no longer use Medicaid and CHIP dollars to fund procedures that fail to meet the evidentiary standard our children deserve," Health and Human Services Secretary Robert F. Kennedy Jr. said in a press statement about the rule.
Under the new rule, which goes into effect Oct. 13, states can still fund certain treatments—including hormone therapies, puberty blockers, and some surgical procedures—but federal dollars will be restricted. Mental health services for transgender youths will still be funded through Medicaid.
The cuts will heavily impact the low-income families who rely on Medicaid to access certain treatments that they believe to be necessary for a young person’s well-being.
“There will be legal challenges to this rule,” Shannon Minter, legal director for the National Center for LGBTQ Rights tells TIME. “I believe it will be deemed to be unlawful when it's challenged.”
This is not the first push to limit gender-affirming care access to minors. According to policy nonprofit KFF, at least 27 states have enacted legislation to that effect, and at least 50% of transgender youths ages 13 to 17 live in those states.
Gender-affirming care refers to a wide range of social, psychological, behavioural, or medical interventions used to help affirm a person's gender identity. These therapies can be particularly useful for transgender people who experience gender dysphoria, which the American Psychiatric Association defines as “distress caused by the discrepancy between one’s experienced/expressed gender and one’s assigned gender and/or primary or secondary sex characteristics.”
According to Minter, there is a misconception over how severe a minor’s dysphoria must be in order to get access to gender affirming care before they turn 18.
“In order to qualify for this care, a young person has to be experiencing very severe, prolonged distress,” Minter says. “I think maybe some people have the misconception that this care is being provided to kids just who are gender nonconforming or who are just identifying as transgender, but that is not the case.”
The number of people who rely on Medicaid and CHIP for gender-affirming care is not publicly available, but in 2023 the spending from both programs on those services totaled $31 million.
Trump wrote about the ruling on social media Tuesday, saying that he directed CMS Administrator Dr. Mehmet Oz to enact the new restrictions.
“We are not going to pay for our innocent children to undergo these barbaric surgeries and practices, which result in unthinkable and irreversible harm to their young bodies,” the post said.
Oz said in a press release that the rule will protect children and is “following the science, saving taxpayer dollars, and, most importantly, protecting children from potentially irreversible harm so they can truly flourish.” TIME has reached out to the CMS for additional comment.
LGBTQ+ advocates say the change is dangerous for minors who rely on gender-affirming care.