The Trump administration has decided not to finalize a proposed rule that would have blocked Medicare and Medicaid funding for hospitals providing gender-affirming care to minors. This decision comes after a period of intense debate and public comment, with medical groups and advocates weighing in on both sides of the issue.
The proposed rule, which was announced in December, would have prohibited hospitals from receiving federal funding if they provided certain types of gender-affirming care to minors. This care typically includes therapy and medications, with surgery being rare for those under age 18. The Centers for Medicare and Medicaid Services (CMS) stated that they do not comment on future rulemaking or speculate on potential actions, but emphasized that the administration rejects ideologically driven surgical interventions on vulnerable children.
Victory for Trans Rights, but Not a Retreat by HHS
Sam Bagenstos, a professor at Michigan Law and former general counsel at the Department of Health and Human Services (HHS) under the Biden administration, described the decision as a victory for people who are defending the rights and interests of trans people. However, he noted that this does not indicate a broader retreat from the Trump administration’s aggressive posture on transgender issues.
Bagenstos explained that the proposed rule was unprecedented because it would have prohibited certain treatments for a specific population. He argued that the rule seemed unlawful in various ways, including violating the Medicare Act, which states that Medicare and Medicaid cannot be used to control the practice of medicine within states.
Medical Groups Opposed the Change
The American Medical Association and the Children’s Hospital Association both submitted comments urging the agency to rescind or withdraw the proposed rule. These medical groups argue that puberty blockers and sex hormones are safe and effective for transgender young people. Despite this, gender-affirming care for youth is banned in 27 states, with many hospital clinics either continuing to operate or shutting down due to pressure from the Trump administration.
The pressure has come in various forms, including another rule that would bar federal Medicaid reimbursement for transgender pediatric patients and a declaration from Health Secretary Robert F. Kennedy Jr. aimed at redefining the standard of care. Interestingly, the press release issued when these actions were unveiled in December is now missing from the HHS website, as is the Kennedy declaration document.
Will Hospitals Resume Care for Trans Youth?
Katie Keith, director of the Health Policy and the Law Initiative at Georgetown University and former Biden administration official, believes that the decision not to finalize the rule should give hospitals more confidence to either resume or continue offering gender-affirming care. She argues that because the rule was never in effect, hospitals should have been providing this care all along.
Kellan Baker, a senior adviser for health policy at the Movement Advancement Project think tank, agrees that this decision is a positive sign. However, he cautions that the administration is continuing to show its ultimate goal is eliminating healthcare for trans people. The Medicare and Medicaid rule could theoretically be revived at some point, with a final action date set for December 2028, just before President Trump leaves office.
