Trump’s Department of Health and Human Services (HHS) seeks to end all Medicaid and Medicare funding for young people’s gender-affirming care (GAC), according to newly proposed rules shared by NPR. A trans activist said the rules would amount to a “de facto national ban” on GAC.

The proposed rules would prohibit all federal Medicaid and Medicare funding — as well as funding through the federal Children’s Health Insurance Program (CHIP) — for any services at hospitals that provide GAC for trans youth.

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“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,” Katie Keith, director of the Center for Health Policy and the Law at Georgetown University, told NPR.

Terry Schilling, president of the American Principles Project, a right-wing think tank that has pushed national transphobia as an effective Republican political strategy, said of the proposed rules, “I think these restrictions are very good. It’s going to change the entire transgender industry, and it’s going to take away a lot of their funding streams.”

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“This would be a de facto national ban,” wrote trans activist and civil rights attorney Alejandra Caraballo via Bluesky. “There would still be providers in blue states that don’t take federal funding but the large interdisciplinary teams of just a few years ago would be nearly impossible to maintain. The result is that the care that remains would largely be underground with worse support and likely outcomes.”

“They’ll never be able to fully ban this care,” Caraballo added. “There will always be providers willing to provide it like abortion. Even without access to providers, many trans youth will simply go DIY [do-it-yourself] like trans folks have done for decades. They’re not actually banning this care, they’re making it less safe.”

The administration’s “toxic” war on gender-affirming care

Though there is no federal law banning gender-affirming care, the current presidential administration has sought to eradicate the practice through a January executive order (that has since been blocked by several courts). The order instructed the DOJ to extend the time that patients and parents can sue gender-affirming doctors and to use laws against false advertising to prosecute any entity that may be misleading the public about the long-term effects of gender-affirming care (GAC).

In April, Bondi issued a memo to DOJ employees, telling them to investigate and prosecute cases of minors accessing gender-affirming care as female genital mutilation (FGM), even though hospitals don’t conduct such female genital surgeries. The memo threatened to jail doctors for 10 years if they provide gender-affirming care to young trans people.

The following June, the DOJ sent subpoenas to 20 medical providers who offer GAC to trans youth, demanding patients’ Social Security numbers, emails, home addresses, and information on the care they received, as well as other sensitive information dating back to January 2020. A federal judge blocked the subpoena in one instance and accused the DOJ of going on a “bad faith” “fishing expedition” to interfere with states’ rights to protect GAC within its borders, to harass and intimidate providers from offering such care, and to dissuade patients from seeking such care.

Fewer than 3,000 teens nationwide receive puberty blockers or hormone replacement therapy, according to a 2025 JAMA analysis of private insurance data. Gender-affirming care is supported by all major medical associations in the U.S., including the American Medical Association, the Endocrine Society, and the American Academy of Pediatrics, as safe and life-saving for young people with gender dysphoria.

One doctor interviewed by The Washington Post called the federal government’s crusade against gender-affirming care a “toxic plan” that will force some patients to detransition, potentially forcing them into adverse psychological and physical effects, including increased anxiety, depression, and the development of unwanted physical changes.

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