CMS ends Medicaid, CHIP funding for gender-affirming care for minors

The Centers for Medicare and Medicaid Services (CMS) has finalized a rule that will prohibit the use of federal Medicaid and Children’s Health Insurance Program (CHIP) funds to pay for puberty blockers, cross-sex hormone therapy and gender-related surgeries for minors, according to a CMS news release. CMS is labeling the care “sex-rejecting procedures.”

Medicaid and CHIP together cover more than 35 million children nationwide. Under the final rule, states will no longer be able to draw down federal matching funds for gender-affirming medical treatment provided to Medicaid beneficiaries younger than 18 or CHIP enrollees younger than 19, though states may continue to cover the services using only state dollars if they choose. The rule takes effect Oct. 13 and applies solely to federal funding rather than imposing an outright coverage ban. Children currently receiving hormone therapy can keep federal coverage during a tapering period of up to six months, and the rule does not affect mental health services covered through Medicaid or CHIP.

“Today, we are ending federal taxpayer funding for sex-rejecting procedures on children,” U.S. Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. said in the news release. “These interventions carry serious risks and can cause irreversible harm. The federal government will no longer use Medicaid and CHIP dollars to fund procedures that fail to meet the evidentiary standard our children deserve.”

CMS said the decision follows an HHS review of national and international research that identified evidence gaps and safety concerns, including the United Kingdom’s Cass Review and a February 2026 position statement from the American Society of Plastic Surgeons recommending against gender-related surgery in patients younger than 19. The agency framed that statement as a sign that clinical consensus is shifting away from earlier guidance from groups including the American Medical Association, the American Academy of Pediatrics and the World Professional Association for Transgender Health, which have historically supported individualized, guideline-based access to the treatments for adolescents with gender dysphoria.

At least 27 states, including Alabama, Kentucky and Ohio, already restrict gender-affirming care for minors under state law. Health plan and state Medicaid program administrators in those states will need to determine whether to fund continued coverage entirely with state dollars or align state policy with the new federal funding restriction.

Medical societies and advocacy groups remain opposed to the ruling. Groups including the American Academy of Pediatrics and the Human Rights Campaign have supported guideline-based access to puberty blockers and hormone therapy for adolescents with gender dysphoria.

“Every young person is entitled to the health care that they, their parents, and their medical providers agree that they need, without politicians interfering with these important and highly personal decisions,” Human Rights Campaign President Kelley Robinson said in a statement. “And yet, rather than working to make healthcare more affordable and accessible, the Trump administration continues to obsess over the healthcare needs of trans youth, this time by cutting off health insurance coverage for those who rely on Medicaid and CHIP to access that care.”

“Children deserve our protection, not experimental interventions that pose serious risks and convey no proven benefits,” CMS Administrator Mehmet Oz, M.D., said in the news release. “By cutting off federal funds for these sex-rejecting procedures, we're following the science, saving taxpayer dollars, and, most importantly, protecting children from potentially irreversible harm so they can truly flourish.”