Transgender young people and their families rallied outside the Supreme Court in May 2023 after an event called the Trans Youth Prom in Washington, DC.
Marvin Joseph/The Washington Post via Getty Images
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The Trump administration finalized a new health care policy that has been in the works for months: No federal dollars can be used to pay for gender-affirming care for children covered by Medicaid or the Children's Health Insurance Plan.
"Every time you wake up, it feels like — what's going to happen next?" says the mother who asked NPR to identify her by her initials, A.W. "What else are they going to take away from us and our kids, to keep them thriving?"
A.W., who is the parent of a transgender teenager, asked not to use her full name because she fears her family could be targeted or her children could be taken away by the federal administration.
The population affected by the rule the administration finalized on Tuesday is quite small. Health research organization KFF estimates there are 130,000 transgender people under age 18 who live in states where gender-affirming care is still available — many states have banned the care after a flurry of state laws in the last few years.
A.W.'s family is in that small group. After her husband's company went out of business, they lost their health benefits, and are now enrolled in Medicaid. They also rely on food assistance, and A.W. says those cuts have been hard on them too.
A longtime Republican herself, A.W. says she never would have believed her family would need this help. "But we do need it," she says. "We need it really badly right now because my husband is still unemployed."
She says she knew the rule restricting access to transgender care through Medicaid was coming, since it was proposed in December. Still, when it was published, she felt panicked. "The initial just — what are we going to do?"
The rule is significant, says Katie Keith, director of the Center for Health Policy and the Law at Georgetown. "I'm not aware of any other times that the federal government has prohibited federal funds in this way for a specific patient population with a particular diagnosis," she says. She calls it "unprecedented" and "untested."
Youth enrolled in Medicaid or CHIP could still receive care if the states they live in decide to backfill the money the federal government will be withholding. Exactly how states will respond is unclear, says Lindsey Dawson, director of LGBTQ Health Policy at the nonpartisan health research organization KFF. "We'll have a better understanding of who will be impacted by this when we understand which states are going to continue to offer these services," she says.
In a social media video about the final rule, Dr. Mehmet Oz, the administrator of the Centers for Medicare and Medicaid Services (CMS), explained the agency's reasoning. "When the harms of sex-rejecting procedures are so serious and the evidence is weak, the government cannot keep signing these checks," he said.
CMS did not make Oz available for an interview or answer NPR's questions about the rule.
Days after the rule was published, the Trump administration released a report called "Wolves in White Coats," which features the stories of young people who have de-transitioned, meaning they once identified as transgender but don't anymore. The report accuses doctors and hospitals of being driven by greed and of using fraudulent billing practices.
None of the named authors and contributors to the report are government employees, and many have ties to anti-trans advocacy work. CMS did not answer NPR's questions about the role HHS played in developing the report.