Restrictions Take Effect on October 13
The Centers for Medicare & Medicaid Services has finalized a rule ending federal funding for certain medical procedures provided to transgender minors. Published in the Federal Register, the regulations are scheduled to take effect on October 13, 2026.
The restrictions cover Medicaid beneficiaries under the age of 18 and participants in the Children’s Health Insurance Program under the age of 19. The rule applies to puberty blockers, cross-sex hormone therapy and surgical interventions intended to alter a patient’s sex characteristics.
The Rule Restricts Funding Rather Than Banning Procedures
The measure does not impose a nationwide prohibition on the procedures themselves. Instead, it prevents federal Medicaid and CHIP funds from being used to pay for them.
States may continue covering the services entirely with state funds outside the federally matched programs. The rule also does not apply to private insurance or prevent providers from offering the procedures where permitted by state law.
CMS estimates that the measure will reduce combined Medicaid and CHIP spending by approximately $235 million over ten years. The projected total includes $138 million in federal savings and $97 million in state savings.
Hormone Therapy Receives a Transition Period
Patients already receiving hormone therapy when the rule takes effect may retain federal coverage for up to six months to allow treatment to be phased out.
The transition provision does not cover surgeries or puberty blockers. Medicaid and CHIP coverage for mental health services will remain in place.
Exceptions are also provided for medically verifiable disorders of sexual development, treatments performed for other medical purposes and care required to address complications caused or aggravated by previous procedures.
Trump Describes the Treatments as Irreversible
U.S. President Donald Trump said he had directed CMS Administrator Mehmet Oz to end the federal funding.
“We are not going to pay for our innocent children to undergo these barbaric surgeries and practices,” Trump stated.
The administration argues that evidence of long-term clinical benefits remains insufficient and that the treatments carry risks of irreversible harm. CMS cited a review conducted by the U.S. Department of Health and Human Services, as well as the United Kingdom’s Cass Review, when explaining its decision.
Medical Groups Oppose the Restriction
The American Academy of Pediatrics and the American Medical Association oppose broad restrictions on funding for gender-affirming care. They maintain that treatment decisions should be made by healthcare professionals together with patients and their parents, based on individual medical circumstances.
According to Reuters, more than 90% of participants in the public consultation opposed the proposed funding restriction. Democratic state attorneys general are also challenging the administration’s actions in court, meaning the final rule could face further legal disputes before or after its implementation.
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