Health care for transgender youth would be almost banned everywhere under new rules: Shots

Access to gender-affirming care for transgender youth will be significantly restricted by the Trump administration under new proposals from the Department of Health and Human Services.

NPR obtained the draft text of a proposed rule that would prohibit federal Medicaid reimbursement for medical care provided to transgender patients under 18 years old. It also prohibits reimbursement through the Children’s Health Insurance Program, or CHIP, for patients under 19 years old.

An additional proposed rule would go even further, blocking all Medicaid and Medicare funding for any services at hospitals that provide pediatric gender-affirming care.

The rules are being prepared to be made public in early November, according to an employee at the Centers for Medicare and Medicaid Services. The employee asked NPR not to use his name because he fears professional retaliation for speaking to the media without permission. An HHS spokesperson did not respond to a request for comment on the expected timeline for releasing the proposed rules.

A virtual ban in all states

Both supporters and opponents of transgender rights agree that, taken together, the upcoming rules could make access to gender-affirming pediatric care across the country extremely difficult, if not impossible. Treatment is already banned in 27 states.

“These rules would constitute a significant escalation in the Trump administration’s attack on transgender health care access,” says Katie Keith, director of the Center for Health Policy and Law at Georgetown University.

“I think it’s really important to note that nothing changes immediately,” she explains. “These would be proposals that would be subject to public comment, it would take months for the Trump administration to issue a final rule, and then, if past is prologue, we would see litigation over the final rules.”

Administrative objectives

In his first days in office, President Trump signed an executive order declaring that the United States “will not fund, sponsor, promote, assist, or support the so-called ‘transition’ of a child from one gender to another.”

In the months that followed, HHS released a report criticizing the research that supports access to this care. A federal suicide prevention lifeline specifically for transgender youth was rescinded, as were hundreds of millions of dollars in funding for LGBTQ-related scientific research. Federal health officials have warned state Medicaid directors to exercise caution, and the Justice Department has announced subpoenas from some children’s hospitals and threatened providers with lawsuits.

“I think these restrictions are very good,” Terry Schilling says of the upcoming rules. Schilling is president of the American Principles Project, a conservative advocacy group. “It’s going to change the entire transgender industry and it’s going to take away a lot of its funding sources.”

He cites a spring opinion poll that found 66 percent of the public opposes Medicaid coverage for this type of care for young people.

“They think that if you want to have a sex modification procedure, you should pay for it,” says Schilling. “The American people fully support this effort.”

New spectacular expansion of power

The proposal to condition a hospital’s participation in Medicaid and Medicare on stopping gender-affirming care for young people represents an “unprecedented” use of executive branch power to control what medical care is available in hospitals, Keith says.

“Because Medicare is a very large portion of many hospitals’ revenues,” she explains, the rule would essentially force hospitals to end their gender-based care. programs for transgender youth. This would mean that all patients in these programs – whether they have Medicaid or private insurance – would no longer have access.

That’s not how the federal government normally uses this type of rule, Keith says. She served in the Biden administration on the Gender Policy Council and worked on some “requirements of participation” regulations for Medicare and Medicaid, she said. “They’re so basic, it’s like you have to have a crash cart [with] enough medicine to help a pregnant woman in crisis. »

Instead of health and safety standards, this proposal would ask hospitals “to completely stop offering a certain type of care to a certain patient population,” she said.

Rutgers University law professor Katie Eyer questions whether such a rule would survive a legal challenge. “But if it were successful, I shudder to think what this administration would do with such a tool in its hands,” she said. This could open the door to any White House denying any federal funding to hospitals for providing medical care that it disfavors.

“It’s clear that this will happen,” says Lindsey Dawson, director of LGBTQ health policy at KFF, a nonpartisan health research organization.

Yet the timing of its release remained a mystery for months. Both proposed rules — but not the rules themselves — appeared on a government docket over the summer, and it’s unclear why they haven’t been published yet, Dawson says.

“Obsessive concentration”

The administration’s efforts on transgender issues extend well beyond health and youth policy. The Federal Trade Commission recently held a workshop “on unfair or deceptive trade practices in ‘gender-affirming care’ for minors.” The army expelled transgender soldiers. Universities were told that their federal funding was contingent on adopting anti-transgender policies on issues such as bathroom access.

Even the impending defunding of food assistance, or SNAP, is linked to Democratic support for “gender mutilation procedures,” according to a banner on the Department of Agriculture’s website.

“It’s never-ending,” Eyer says. “It really is an obsessive concern that has been deployed across the entire administration.”

Warning letters and canceled grants, among other things, have had a considerable deterrent effect. In states where care is still legal, many clinics and hospitals have ended their gender-affirming care programs. If these rules were to take effect, the remaining programs would likely follow suit.

“There are real people behind this,” says Eyer, who is also the parent of a transgender child. “People are really scared and hurting because of this wave of attacks on the trans community.”

It’s still legal, even if access is decreasing

Gender-affirming care aimed at young people — including puberty-blocking drugs, hormones and, rarely, surgery — does not actually violate federal law, Eyer notes. And, despite recent political pressure, no major U.S. medical organization has changed its clinical guidelines that support these treatments as appropriate and safe.

In the United States, about 3% of young people identify as transgender or nonbinary, although not all seek medical treatment related to their identity.

Notably, in Utah, a state-commissioned analysis of the evidence recently reached the opposite conclusion than the Trump administration’s transgender report. The University of Utah researchers found there was ample evidence of the benefits and safety of these treatments and wrote that policy restrictions on such care for young people “cannot be justified based on the quantity or quality of medical scientific findings or concerns about potential future regrets.”

The draft text of the proposed federal rule obtained by NPR does not mention Utah’s analysis, nor does it cite the American Academy of Pediatrics, whose guidelines also support access to care.

According to Eyer, the publication of these rules will provide the opportunity to legally challenge them.

“It will be subject to arbitrary and capricious scrutiny, and a court will likely look closely at the factual basis that actually underlies it,” she says. “It’s actually preferable to what we’ve experienced so far, which is lawless coercion.”

Diane Webber edited this story.