Mehmet Oz, the newly confirmed administrator of the Centers for Medicare & Medicaid Services (CMS), is telling state Medicaid officials to stop covering gender-affirming care for transgender youth. Medicaid is the joint state-federal program that covers health care for people with low incomes, including 40% of minors in the U.S.

A letter sent from the CMS to state Medicaid directors said that the program should stop reimbursing gender-affirming care for minors, including puberty blockers, hormone therapy, and surgical interventions. The letter says that there is an “underdeveloped body of evidence” supporting gender-affirming care despite the research showing that it’s a safe and effective treatment for gender dysphoria, which is supported by all major medical organizations in the U.S. The letter also cites the U.K.’s “Cass review,” a report on gender-affirming care that has been criticized for its bias against transgender people.

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In a statement, Oz – who was confirmed by the Senate earlier this month – said that gender-affirming care can lead to sterilization, and that’s why the CMS is cracking down on it.

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“Medicaid dollars are not to be used for gender reassignment surgeries or hormone treatments in minors – procedures that can cause permanent, irreversible harm, including sterilization. CMS will not support services that violate this standard or place vulnerable children at risk.”

Republicans in the Senate at first balked at Oz’s nomination, not due to his lack of qualifications for leading the agency but because he had, on television, expressed more liberal views when it came to acknowledging that trans kids exist and supporting reproductive freedom. The White House assured Senate Republicans that Oz is now transphobic.

Taking away health care from trans minors in low-income families just a week into his tenure at the CMS may reassure Republicans of Oz’s conservative credentials.

In January, the president signed an executive order targeting gender-affirming care for trans minors and some young adults. The order told the Department of Health and Human Services (HHS) – under which the CMS is organized – to “take all appropriate actions to end the chemical and surgical mutilation of children,” including by changing “Medicare or Medicaid conditions of participation or conditions for coverage.” Referring to gender-affirming care as “mutilation” is a tactic used by anti-transgender activists to sway public opinion against the care that has been shown to save lives.

Former HHS official Adrian Shanker, who worked at the department under former President Joe Biden, said that the CMS letter misuses regulations to limit gender-affirming care coverage.

“I don’t think this letter is using those regulations in good faith,” Shanker told Advocate. “This letter is using highly politicized language that is not grounded in the mountain of evidence that supports the underlying health and well-being of trans youth.”

“It frankly looks like a campaign document,” he continued. “It looks like a document written by anti-trans activists rather than by public health professionals and health care leaders.”

Shanker pointed out that the letter itself is not legally binding but that it will lead states to cut off coverage for gender-affirming care.

“The significant fear here is that this ‘Dear State Medicaid Director’ letter will be utilized to preclude access to care even further in some states,” he said. “And the risk of that is actually very significant because we have incredible amounts of data that confirms the health impacts of denying access to care for trans youth.”

In 2015, trans reality TV personality and author Jazz Jennings appeared on Oz’s talk show, and he complimented her mother for being supportive.

“I love the support you’ve given your daughter,” Oz said. “It’s wonderful. And you can see the beautiful young woman she’s becoming because of it.”

This was before Oz entered the political realm. The exchange, though, led to Sen. Josh Hawley (R-MO) sending a letter demanding the administration explain the ten-year-old episode.

“Have your views on this issue changed since you hosted your television show?” Hawley’s letter demanded, asking if Oz supports the administration’s position that “gender transition procedures for minors should be banned.”

In a statement, a spokesperson for the White House said that Oz would follow the president’s views on the matter, saying that everyone in the administration will follow his “playbook.”

Editor’s note: This article has been updated to make it clear that CMS’s letter does not immediately ban coverage for gender-affirming care.

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