HHS unveils rules to bar federally funded gender affirming care for minors

The Department of Health and Human Services on December 18 and 19 unveiled a coordinated set of proposed regulatory actions designed to sharply restrict access to gender affirming medical care for people under age 18. The package, presented at a press conference at HHS headquarters in Washington, said the measures implement President Donald Trump’s executive order directing the department to end what the administration called “sex rejecting procedures” on children because of the risk of “irreversible harm.”

The most concrete element announced would direct the Centers for Medicare and Medicaid Services to issue a notice of proposed rulemaking that would make the performance of certain gender related procedures on minors a condition for non participation in Medicare and Medicaid. HHS framed the step as a way to stop federal insurance payments to hospitals and clinics that provide the care. The department said in a press release, “Nearly all U.S. hospitals participate in Medicare and Medicaid and this action is designed to ensure that the U.S. government will not be in business with organizations that intentionally or unintentionally inflict permanent harm on children.”

HHS also disclosed a proposed revision to Section 504 of the Rehabilitation Act of 1973, clarifying that statutory definitions of disability and individual with a disability would exclude gender dysphoria except where it results from physical impairments. Separately, Secretary Robert F. Kennedy Jr. signed a declaration finding that gender affirming surgeries do not meet “professionally recognized standards of health care,” and said doctors who perform these procedures would be deemed “out of compliance with those standards.”

The administration said the package includes actions by the Food and Drug Administration, though officials described the CMS and civil rights revisions as the most fully detailed components. HHS has previously released a review in May concluding that the quality of evidence regarding the effects of gender affirming care for minors is very low, and regulators framed the new proposals as the next step in implementing that review and the president’s orders.

Public health experts and pediatric advocates responded sharply. The American Academy of Pediatrics called the actions “unprecedented” and said they represented a “baseless intrusion in the patient physician relationship.” Kressly of the pediatrics academy said the measures “do nothing to bring down health care costs and instead, unfairly stigmatize a population of young people.”

Policy analysts warn the proposals would have immediate practical effects. Federal scrutiny of providers intensified earlier in 2025, with investigations beginning in July that prompted more than 20 hospitals across the country to roll back or end programs serving minors and some young adults. If finalized, the rules would effectively bar federally funded gender affirming care for minors even in states where the care remains legal, creating a patchwork of access determined by funding streams rather than clinical judgment.

The proposals now enter formal rulemaking, with CMS expected to publish an NPRM and a public comment period to follow. Legal challenges are likely, and health systems, states and advocacy groups are already preparing to contest the measures. For families and clinicians, the shift underscores how federal funding decisions and civil rights definitions can reshape care access and intensify inequities for low income and publicly insured transgender youth.