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A Wave of Federal Actions Targets Gender-Affirming Care for Minors
A series of coordinated federal actions targeting gender-affirming medical care for individuals under 18 years old has prompted legal challenges, hospital policy changes, and ongoing debate across the United States. The measures, announced by the Trump administration and the U.S. Department of Health and Human Services (HHS) in late 2025, include proposed funding rules, a policy declaration, and support for a medical society's recommendation on surgical timing. A federal judge has blocked a key HHS declaration on procedural grounds.
Federal Administrative Actions
Proposed HHS Rules
On a Thursday in late 2025, Health Secretary Robert F. Kennedy Jr. announced a set of proposed rules. Dr. Mehmet Oz, head of the Centers for Medicare and Medicaid Services (CMS), detailed two specific proposals:
- Medicaid Reimbursement Prohibition: One rule would prohibit federal Medicaid reimbursement for medical care provided to transgender patients under 18 years of age.
- Hospital Funding Block: A second rule would block all Medicaid and Medicare funding for any services at hospitals that provide pediatric gender-affirming care.
Because most U.S. hospitals participate in Medicare, these rules, if finalized, could have a broad impact on healthcare services.
The proposed rules are subject to a 60-day public comment period after publication in the Federal Register and will not be implemented immediately.
HHS Policy Declaration
In December 2025, HHS issued a declaration characterizing certain treatments for gender dysphoria in children and adolescents—including puberty blockers, hormone therapy, and surgeries—as unsafe and ineffective. The declaration informed healthcare providers that offering these types of care could result in their exclusion from federal health programs such as Medicare and Medicaid.
The declaration was based on an internal peer-reviewed HHS report that advocated for a greater reliance on behavioral therapy. The report questioned treatment standards from the World Professional Association for Transgender Health and raised concerns about adolescents' capacity to consent to treatments that may have irreversible effects, including potential infertility.
Support for Surgical Timing Recommendation
Deputy Health and Human Services Secretary Jim O'Neill issued a press release supporting a position statement from the American Society of Plastic Surgeons (ASPS) that recommends delaying gender-related surgery until a patient is at least 19 years old.
The ASPS clarified that this statement is not a reversal of a previous stance nor a new clinical practice guideline, but rather a recommendation based on current evidence and the existing legal and regulatory environment.
Legislative Developments
House of Representatives Bills
On the Wednesday preceding the HHS announcement, the U.S. House of Representatives passed a package of healthcare bills. Included in this package was:
- A bill by Rep. Marjorie Taylor Greene (R-Ga.) that would criminalize the provision of gender-affirming care to transgender minors, with penalties of fines or up to 10 years in prison.
- A bill by Rep. Dan Crenshaw (R-Texas) that would prohibit Medicaid reimbursement for gender-affirming care for youth.
Both bills require Senate approval to become law.
Federal Executive Order
Upon entering his second term, President Trump issued an executive order stating that the United States would not "fund, sponsor, promote, assist, or support the transition of a child from one sex to another" and committed to enforcing laws that restrict such procedures.
Legal Challenges
Lawsuit by 19 States and D.C.
A coalition of 19 states and the District of Columbia filed a lawsuit in U.S. District Court in Eugene, Oregon, against HHS, Secretary Kennedy, and the HHS Inspector General. The lawsuit alleged that the HHS declaration was inaccurate and unlawful, seeking to compel providers to cease offering gender-affirming care while bypassing legal requirements for public notice and comment. New York Attorney General Letitia James is leading the lawsuit.
Federal Judge Blocks Declaration
On March 13, 2025, Judge Mustafa Kasubhai of the U.S. District Court in Oregon ruled that the government exceeded its authority by issuing the declaration. The ruling focused on Secretary Kennedy not following proper administrative procedures. The judge denied the defendants' motion to dismiss the case.
Attorney General James stated that the ruling affirmed that healthcare services for transgender youth remain legal and that the federal government cannot "intimidate or penalize providers."
DOJ Subpoenas and Legal Action
The U.S. Department of Justice (DOJ) issued criminal subpoenas to multiple hospitals, including NYU Langone Medical Center and Lucile Packard Children's Hospital Stanford, seeking patient files of transgender youth, personnel files of clinicians, and other documents.
- A federal judge in the Northern District of California granted a temporary restraining order preventing hospitals in California from producing documents in response to these subpoenas. The action was prompted by a lawsuit filed by six families.
- A federal judge in Maryland rejected a bid to certify a nationwide class of families of transgender youth to fight administrative subpoenas.
Impact on Healthcare Providers
Hospital Program Closures
Multiple hospitals across the country have discontinued gender-affirming medical care for minors, citing legal and financial risks from federal policy changes.
- Baystate Health (Springfield, Massachusetts): In February, the hospital announced it would no longer provide gender-affirming medications to minors, offering only counseling. The hospital noted that nearly 70% of its patients rely on Medicaid and Medicare.
- Children's Wisconsin (Milwaukee, Wisconsin): The health system stated it was "currently unable to provide gender affirming pharmacologic care" due to "escalating legal and federal regulatory risk." It continues to offer mental health services.
- UW Health (Madison, Wisconsin): The system announced a pause on prescribing puberty blockers and hormone therapy for patients under 18 "due to recent federal actions."
- Hospitals in California, Illinois, and New York have also closed similar programs.
Private Clinic Response
TransHealth, a private clinic in Northampton, Massachusetts, reported it expects to absorb more than 200 former Baystate patients. The clinic's CEO stated the clinic can continue operations due to private donations and less dependence on government insurance programs.
Medical Community Positions
Opposition to Federal Actions
Major medical organizations have challenged the administration's stance:
- The American Academy of Pediatrics (AAP) , representing 67,000 pediatricians, asserted that the federal policies "misconstrue the current medical consensus and fail to reflect the realities of pediatric care." The AAP declined interview requests, with a representative stating pediatricians were "too scared of retaliation" to comment publicly.
- The American Medical Association (AMA) clarified that it supports evidence-based treatment and that surgical interventions in minors should generally be deferred until adulthood. The AMA stated this is a clarification, not a reversal.
- The American Psychological Association expressed "deep concern about recent federal actions that not only challenge the scientific understanding of gender identity but also potentially jeopardize the human rights, psychological health, and well-being of transgender and nonbinary individuals."
- The American Society of Plastic Surgeons (ASPS) issued a position statement recommending delaying gender-related surgery until a patient is at least 19, clarifying it is not a new clinical practice guideline.
Support for Restrictions
Acting CDC Director Jim O'Neill stated, "Men are men. Men can never become women. Women are women. Women can never become men," and referred to gender identity concepts as "a hatred for nature as God designed it." Health Secretary Kennedy alleged that doctors and medical groups had "peddled the lie" regarding the benefits of these treatments.
Broader Policy Context
State-Level Bans
Over half of U.S. states (at least 27) have enacted laws banning gender-affirming care for young people since 2021. The U.S. Supreme Court recently upheld Tennessee's ban on specific gender-affirming care, which may impact the legal stability of similar state-level restrictions.
Demographics and Care Statistics
According to a CDC survey, approximately 3% of teenagers aged 13-17, totaling around 700,000 individuals, identify as transgender. A KFF poll found that less than one-third of transgender individuals use medication related to their identity, and 16% have undergone surgery. For minors, surgery is rare; one study found an average of 800 top surgeries per year in patients aged 18 or younger between 2016 and 2020.
Malpractice Lawsuit
A patient won a $2 million malpractice lawsuit in New York against her plastic surgeon and psychologist after undergoing a mastectomy as a minor and later regretting the procedure.
Future Outlook
Matthew Cook, CEO of the Children's Hospital Association, warned that if finalized, the proposed funding rule could establish a precedent allowing "all kinds of specialized health care treatments to be withheld based on government-mandated rules," potentially affecting "millions of families." Attorneys general in multiple states have indicated intentions to challenge the proposed rules, and the ACLU has announced plans for legal action.