The Trump administration is moving forward with two sweeping federal rules that could sharply limit access to gender-affirming care across the United States. The story was first reported by NPR, detailing proposals from the Centers for Medicare and Medicaid Services (CMS) that would restrict coverage and funding for transgender care under key federal programs.
What the New Rules Would Do
According to NPR’s report, the first proposed rule would bar Medicare and Medicaid from covering gender-affirming medical care for anyone under the age of 19. The second would deny federal funding to hospitals that provide this care to minors, effectively forcing institutions to choose between offering medically recognized treatments or keeping their federal reimbursements.
Because most hospitals rely heavily on Medicare and Medicaid funds, health policy experts say the move could cause many to stop providing gender-affirming care altogether, even to privately insured patients. Health law scholar Katie Keith told NPR that such financial pressure “could create a chilling effect that cuts off access entirely.”
The Wider Push Against Trans Health Care
The new CMS rules are part of a larger pattern. The Trump administration has been advancing multiple efforts to limit transgender health rights, including attempts to remove gender-affirming care from “essential health benefits” defined under the Affordable Care Act. The Department of Health and Human Services (HHS) has also released reports questioning the safety of gender-affirming care for minors, despite decades of evidence and consensus from major medical organizations that affirm its necessity and effectiveness.
Earlier this year, a separate HHS proposal sought to penalize hospitals and clinics that provide transition-related care to minors by tying compliance to federal funding. Advocacy groups warn that the new CMS rules could expand that strategy nationwide, impacting both public and private facilities.
The Legal Landscape
These policy shifts come amid ongoing court battles over transgender rights in health care. In one major case, United States v. Skrmetti, the Supreme Court upheld Tennessee’s ban on gender-affirming care for minors, signaling a willingness to allow states to enforce similar restrictions.
At the same time, a separate court challenge earlier this year temporarily blocked the administration from withholding funds from hospitals that treat transgender minors. The conflicting rulings highlight the uncertain future for trans healthcareproviders and patients, as courts weigh states’ rights against federal protections.
What This Means for Patients
While the proposed CMS rules target youth care, the consequences could reach far beyond that. If hospitals fear losing federal funding, they may cut back on transgender care for adults as well, particularly those on Medicare or Medicaid. Providers who serve both minors and adults may also reduce or eliminate services altogether.
For many transgender people, these new restrictions represent another attack on access to essential medical care. Advocates urge trans individuals and allies to stay informed, connect with local support networks, and reach out to state officials to demand protection for gender-affirming health services.
The Bottom Line
The proposed CMS rules would restrict federal funding and insurance coverage for gender-affirming care. While aimed at minors, the ripple effects could endanger access for transgender adults as well, making this one of the most far-reaching federal actions against trans health care in recent years.
