The Trump administration is moving to cut off federal support for medical interventions that attempt to change a child’s sex, targeting both hospital practices and public insurance funding.
The U.S. Department of Health and Human Services announced proposed regulations to implement President Donald Trump’s executive order directing HHS to end “sex‑rejecting procedures” on minors.
These procedures include puberty blockers, cross‑sex hormones, and surgeries intended to make a child’s body match an asserted gender identity different from his or her biological sex. HHS says these interventions expose children to irreversible harms such as infertility, impaired sexual function, reduced bone density, altered brain development, and other permanent physiological effects.
Under one proposed rule, the Centers for Medicare & Medicaid Services would bar hospitals that participate in Medicare and Medicaid from performing these procedures on anyone under 18. Because nearly all U.S. hospitals depend on those programs, this would effectively force hospitals to choose between performing sex‑rejecting procedures on minors and remaining eligible for federal reimbursement.
A separate CMS proposal would prohibit federal Medicaid funding for sex‑rejecting procedures on minors and would apply the same ban to Children’s Health Insurance Program funding for individuals under 19. HHS notes that 27 states already exclude these interventions for children from Medicaid coverage, and the new rule would extend that restriction nationwide on the federal side.
At the same time, HHS Secretary Robert F. Kennedy Jr. signed a formal declaration, based on a peer‑reviewed HHS report, concluding that these pediatric interventions “do not meet professionally recognized standards of health care.”
By that declaration, practitioners who perform sex‑rejecting procedures on minors would be deemed out of compliance with accepted standards, bolstering the administration’s argument that federal programs should not pay for or partner with providers offering them.
The Food and Drug Administration is also taking enforcement steps related to sex-rejecting treatments for minors. The agency is issuing warning letters to 12 manufacturers and retailers for what it calls illegal marketing of breast binders to children for the treatment of gender dysphoria, noting that binders are Class I medical devices typically used for purposes such as post‑mastectomy recovery.
FDA Commissioner Marty Makary said the agency views the marketing of these products to children as “alarming” and warned that, if companies do not correct course, the FDA may escalate to import alerts, product seizures, or injunctions.
HHS is also moving to unwind a Biden‑era civil rights interpretation. The Office for Civil Rights proposed revising its Section 504 regulations under the Rehabilitation Act to explicitly exclude “gender dysphoria” not caused by physical impairments from the definitions of “disability” and “individual with a disability.”
Deputy Secretary Jim O’Neill said the Biden administration “abused” disability law by using it to pressure providers and programs to support sex-rejecting interventions for minors.
The new rule is intended to reassure entities receiving HHS funds that policies restricting or prohibiting sex‑rejecting procedures will not be treated as disability discrimination under federal law.
These actions build on HHS’s recent publication of a peer‑reviewed study titled “Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices,” which warns of medical risks associated with attempts to change a child’s sex.
According to claims data cited by HHS, nearly 14,000 minors received sex‑rejecting procedures between 2019 and 2023.
Admiral Brian Christine, the Assistant Secretary for Health, issued a public health message stating that current evidence does not support puberty blockers, cross‑sex hormones, or surgeries as safe and effective treatments for pediatric gender dysphoria.
He argued that providers have an obligation to avoid interventions that expose young people to “a lifetime of harm,” and said children’s health and well‑being, not ideology, should guide clinical decisions.
On Wednesday, the U.S. House passed legislation criminalizing sex-rejecting interventions for minors. However, the legislation faces an uphill battle in the Senate.
Texas passed legislation prohibiting child gender mutilation in 2023. Lawsuits against doctors who have continued to offer sex-rejecting treatments are ongoing.
Vanessa Sivadge, president of Protecting Texas Children, told Texas Scorecard, “As a nurse who blew the whistle to expose unsafe and unethical practices harming children, I fully applaud the U.S. Department of Health and Human Services’ decisive action to bar hospitals from performing sex-rejecting procedures on minors.”
“With this announcement, HHS is finally prioritizing evidence-based care, child safety, and medical integrity over ideology and experimentation,” added Sivadge. “As someone who witnessed firsthand how these horrific procedures were pushed on minors under the guise of ‘care,’ I commend HHS for acting boldly to protect children and uphold the highest ethical standards of medicine.”
