Trump Administration Ends Federal Medicaid and CHIP Funding for Gender-Affirming Care for Minors

The Trump administration on Tuesday finalized a rule barring federal Medicaid and Children's Health Insurance Program dollars from covering gender-affirming care for children and youth, with the policy set to take effect on October 13.

The rule, issued by the Centers for Medicare and Medicaid Services, covers a range of treatments including puberty blockers, hormones, and surgical operations. Gender-affirming surgeries are described as rare among minors.

CMS said the decision follows a review of national and international research conducted by the Department of Health and Human Services. The agencies claim that review identified "significant evidence gaps, documented serious safety concerns, and concluded that the evidence supporting these interventions for children remains insufficient to justify federal taxpayer funding." The specific details of those findings have not been made public.

The rule does not affect federal coverage of mental health services for children, and state dollars could still be used to help cover the treatments for minors.

Major medical organizations have maintained that gender-affirming care is safe and effective when clinical guidelines are followed. The National Alliance on Mental Illness, described as the leading grassroots mental health organization in the United States, has said that access to gender-affirming care can improve mental health outcomes — including when initiated during youth — and that denying such care can worsen mental health symptoms and increase suicide risk.

Gender-affirming care encompasses mental and medical treatments that help bring a person's gender expression in line with their gender identity. It serves transgender individuals as well as cisgender, nonbinary, and intersex people.

Twenty-seven states have enacted restrictions on gender-affirming care for children, according to health policy organization KFF.

President Donald Trump promoted the rule in a Truth Social post on Tuesday and explicitly linked it to the November midterm elections. "Please remember this when you are casting your vote in the Midterm Elections in November," he wrote, underscoring how Republican lawmakers have increasingly used restrictions on transgender healthcare as a political posture ahead of the midterms.

With the October 13 effective date approaching, legal challenges from advocacy groups and state governments opposing the rule are widely anticipated — reflecting the pattern of litigation that has followed earlier executive actions targeting transgender healthcare access.