Donald Trump's New Medicaid Rule Targets Gender-Affirming Care for Minors

The Trump Administration announced Tuesday that it is implementing a rule to restrict federal funding of gender-affirming care for minors.

The rule put forth by the Centers for Medicare and Medicaid Services (CMS) bars Medicaid from paying for what it calls "sex-rejecting procedures for children under 18." Also restricted is funding from Children's Health Insurance Program (CHIP).

"The federal government will no longer use Medicaid and CHIP dollars to fund procedures that fail to meet the evidentiary standard our children deserve," Health and Human Services Secretary Robert F. Kennedy Jr. said in a press statement about the rule.

Under the new rule, which goes into effect Oct. 13, states can still fund certain treatments using their own dollars, but federal dollars will be restricted. Mental health services for transgender youths will still be funded through Medicaid.

"There will be legal challenges to this rule," Shannon Minter, legal director for the National Center for LGBTQ Rights, tells TIME. "I believe it will be deemed to be unlawful when it's challenged."

According to policy nonprofit KFF, at least 27 states have enacted legislation restricting gender-affirming care for minors, and at least 50% of transgender youths ages 13 to 17 live in those states.

The number of people who rely on Medicaid and CHIP for gender-affirming care is not publicly available, but in 2023 the spending from both programs on those services totaled $31 million.

Trump wrote about the ruling on social media Tuesday, saying that he directed CMS Administrator Dr. Mehmet Oz to enact the new restrictions. "We are not going to pay for our innocent children to undergo these barbaric surgeries and practices, which result in unthinkable and irreversible harm to their young bodies," the post said.

Oz said in a press release that the rule will protect children and is "following the science, saving taxpayer dollars, and, most importantly, protecting children from potentially irreversible harm so they can truly flourish."

"It is terribly harmful," Minter says of the rule.

Since the rule was first proposed in December 2025, more than 35,000 public comments were submitted that critiqued it, says Rodrigo Heng-Lehtinen, senior vice president of public engagement campaigns at the Trevor Project. "The Trevor Project's research shows that access to this care is associated with significantly lower rates of depression and suicide risk among transgender and nonbinary young people who receive it," he said in a statement to TIME.

Supporters of Trump's new rule point to medical associations like the American Society of Plastic Surgeons, which published a statement in February advising its members against performing any gender-related surgeries before age 19, saying there was "insufficient evidence" that the benefits outweigh risks. Soon after, the American Medical Association also said surgical interventions generally should be deferred until patients reach adulthood.

Minter says conversations around surgeries are often a red herring, since they are very rare; hormone therapies are much more common. In 2024, researchers found just 108 cases of any gender-affirming surgery among minors between 2018 and 2021, accounting for 0.04% of all transgender youth in the U.S.

The Medicaid restriction helps to fulfill Trump's campaign vow to "stop" gender-affirming care for minors. It is the latest in a series of administration policies affecting transgender people of all ages, including a ban on transgender women and girls in women's sports, restrictions on military service by transgender people, and an executive order recognizing only two "immutable sexes."