The Trump administration will heavily restrict access to gender-affirming care for trans youth under new health proposals, which were leaked to the press.

Exclusively reported by NPR, the new proposals put forth by the Department of Health and Human Services would prohibit federal Medicaid reimbursement for trans patients under the age of 18 and also block all Medicaid and Medicare funding for services at hospitals which provide gender-affirming care to young trans people.

According to an employee who works at the Center for Medicare and Medicaid Services, and spoke with NPR on the condition of anonymity, the rules are being prepared to be released in early November.

Speaking to the outlet, Katie Keith – director of the Center for Health Policy and the Law at Georgetown University – said the proposals mark an “significant escalation” in Trump’s attacks on trans healthcare.

She said: “I think it’s really, really important to note that nothing is changing immediately.

“These would be proposals that would go out for public comment, it would take months for the Trump administration to issue a final rule, and then, if past is prologue, we would see litigation over whatever the final rules are.”

By contrast, Terry Schilling – president of the conservative American Principles Project – feels the restrictions are “very good” because it will take away funding streams for trans healthcare.

“They believe that if you want to get some type of sex-trait modification procedure, you should have to pay for it,” Schilling told NPR. “The American people are fully behind this effort.”

Katie Eyer, professor of law at Rutgers University a the parent of a trans child, questioned if the rules would survive a court challenge but said, if they did: “I shudder to think what this administration would do with such a tool in their hands.”

Eyer went on to say anti-trans policies are “an obsessive focus that’s been deployed across the administration”.

“There are real people behind all this,” Eyer said. “People are really scared and suffering as a result of this onslaught of attacks on the trans community.”

Since his inauguration in January, Donald Trump has signed a raft of anti-trans executive orders including proclaiming that the official policy of the US is that there are “only two sexes”, banning transgender people from serving in the military, barring trans women from female sport and restricting gender-affirming healthcare for trans youngsters under the age 19. He has also moved to eliminate diversity, equity and inclusion programmes across the government and in the military.

There are currently 27 states that have enacted bans on gender-affirming care for trans young people.

According to Human Rights Campaign data, 40.1 per cent – around 120,400 – of trans youth aged 13-17 are living in the states which have passed bans on gender-affirming care.

In May, US House of Representatives very narrowly passed a sweeping tax and spending bill – known as the One Big Beautiful Bill Act – in a 215–214 vote, and which added trillions to the country’s national debt and cut access to healthcare for trans people on insurance programmes.

Under the bill, Medicaid and CHIP would no longer be able to reimburse people of all ages for gender–affirming care, whilst another provision in the legislation set out that Obamacare could not cover “gender transition procedures” as an “essential health benefit”.

Prior to this in December 2024, a month before Trump returned to the White House for his second term, the Senate passed the National Defense Authorization Act for Fiscal Year 2025 – the most recent iteration of the National Defense Authorization Act (NDAA) – which included an anti-trans clause.

The clause set out that Tricare – the US military’s healthcare plan for service members – could no longer “medical interventions” to those under the age of 18 “for the treatment of gender dysphoria that could result in sterilisation”.

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