In a major policy shift, the United States Department of Health and Human Services (HHS) on Thursday, December 18, introduced far-reaching regulatory proposals designed to block minors' access to gender-affirming medical treatments. This initiative represents the most aggressive action taken by the Trump administration to limit healthcare options for transgender youth.
Core Proposals and Financial Implications
The proposed regulations aim to sever Medicare and Medicaid funding for hospitals that offer puberty blockers, hormone therapy, or surgical interventions to individuals under 18. Furthermore, federal Medicaid dollars would be explicitly prohibited from covering such care. The restrictions would also extend to the State Children’s Health Insurance Program (CHIP), as detailed in an official federal notice.
Health Secretary Robert F. Kennedy Jr. defended the move, stating at a news conference, "This is not medicine, it is malpractice." He added, "Sex-rejecting procedures rob children of their futures."
Potential Impact on States and Hospitals
While over half of US states already have laws restricting or banning gender-affirming care for minors, the federal proposals could dramatically alter the landscape in nearly two dozen states where such treatments remain legal. In many of these states, Medicaid, which uses a combination of federal and state funds, currently provides coverage.
The financial threat is significant because nearly all US hospitals participate in Medicare and Medicaid, the government's primary health insurance programs for seniors, people with disabilities, and low-income Americans. Losing access to these payments could jeopardise the financial stability of most institutions and likely deter providers from offering this care to children. Healthcare advocates report that many hospitals have already preemptively halted services in expectation of federal action.
Additional Regulatory Moves and Opposition
Secretary Kennedy also announced that the HHS Office of Civil Rights will propose a rule to exclude gender dysphoria from the federal definition of a disability. In a parallel action, the Food and Drug Administration (FDA) issued warning letters to about a dozen companies, including California's GenderBender LLC and Seattle's TomboyX, which market chest-binding vests. The FDA stated these products can only be legally marketed for approved medical uses, such as recovery after a mastectomy.
These proposed rules directly contradict the guidance of leading medical bodies like the American Medical Association. These organisations have advised governments against restricting care for gender dysphoria, noting that such treatments can be medically necessary and appropriate for some patients. It's important to note that care for minors typically involves a psychological evaluation and social transition first, with puberty blockers or hormones considered later. Surgical procedures on minors are exceedingly rare, according to medical groups.
Broader Political Context and Legal Status
The HHS actions are part of a wider effort by President Donald Trump and Congressional Republicans to roll back protections for transgender Americans. Since returning to office, Trump has signed executive orders recognising only two sexes and aiming to cut federal support for gender transitions for people under 19. The US House recently passed a bill that could imprison healthcare providers for treating transgender patients under 18.
The proposed rules are not yet legally binding. They must undergo a formal rulemaking process, including public comment periods and potential revisions, before taking effect. Legal challenges are widely anticipated. Currently, Medicaid in fewer than half of US states covers gender-affirming care, and at least 27 states have enacted restrictive laws. Federal judges have previously overturned bans in states like Arkansas and Montana as unconstitutional, though those legal fights continue.
Despite the pending process, healthcare experts warn the proposals could have an immediate chilling effect, discouraging providers due to the severe financial risks associated with losing federal funding.
