Hospitals that offer gender-affirming care to minors will be forced to forgo federal insurance funding under a rule proposed by the Centers for Medicare and Medicaid Services, part of an effort by the Trump administration to curtail the practice.

The Department of Health and Human Services said Thursday it will roll out a cross-agency plan to curb access. Medicaid reimbursements for treatment through the Children’s Health Insurance Program, or CHIP, will no longer be offered for those under the age of 19. Hospitals that receive funding through Medicaid and Medicare, the government’s programs for the poor and elderly, also must stop offering the care.

The proposed rules, announced at an HHS press conference on Thursday and posted on a federal website, now face a 60-day public comment period.

Health Secretary Robert F. Kennedy Jr. reversed a Biden-era ruling that included gender dysphoria in the definition of disability. He signed a declaration saying those who provide transgender care are out of compliance with medical standards.

Additionally, the Food and Drug Administration issued warning letters to 12 manufacturers and retailers for their branding of breast binders, with Kennedy saying “illegal marketing” to children was a regulatory violation.

The moves are the latest turn in President Donald Trump’s myriad efforts to curb support and care for transgender people in the U.S. The strategy — largely led by the Department of Justice and the White House — has been immediately met by lawsuits, and experts said the latest rules are likely to also face a wave of litigation once they are finalized.

“These proposed actions would put Donald Trump and RFK Jr. in those doctor’s offices, ripping health care decisions from the hands of families and putting it in the grips of the anti-LGBTQ+ fringe,” said Kelley Robinson, president of the Human Rights Campaign, in a statement.

Kennedy said the health department was bracing for legal challenges to the changes that he said would protect minors. While people are welcome to sue, Kennedy claimed that physicians “betrayed their Hippocratic oath to do no harm” and predicted the agency would win.

“This is not medicine,” he said. “This is malpractice.”

Cutting off funding for gender-affirming care was a top Trump campaign pledge. It is already banned or restricted in 27 states, according to KFF, a nonpartisan health research institute. The new CMS proposal would impact hospitals in the remaining states, including California and New York, and the District of Columbia.

About 75% of U.S. hospitals — roughly 3,600 — would need to update their policies and procedures to be in compliance if the proposed rule is enacted, according to CMS.

Medicaid and Medicare funding is a major source of revenue for the nation’s hospitals. Two-thirds of stays are paid for by public insurance programs at most of the country’s hospitals, according to data published by the American Hospital Association in 2024.

“It would be financially untenable for hospitals to lose revenue from Medicare and Medicaid,” said Lindsey Dawson, director of LGBTQ Health Policy at KFF. “It would likely be quite a clear decision to no longer provide these services.”

Limiting access under CHIP will hit low-income families and those who already struggle to get care the hardest, Dawson said. Federal dollars going to these services are a “drop in the bucket” compared to other types of treatment for kids who utilize the program.

Trump’s Roadmap

In January, Trump signed an executive order to halt funds for hospitals and medical schools that provide transgender care to people under the age of 19. Washington, Oregon and Minnesota sued in February over the order. A judge then issued an injunction, effectively blocking it from being implemented.

The order also directed HHS to release a report on gender dysphoria and gender-affirming care in kids. That report was finalized in November and met with met with intense criticism over its contradictory data. The administration has canceled hundreds of thousands of dollars in LGBTQ+ research and a federal suicide prevention hotline for transgender youth.

The strong-arming from the Trump administration and subsequent warning letters led to multiple children’s hospitals ending access to gender-affirming care over the summer, including Children’s Hospital Los Angeles, one of the largest providers of care in the U.S. Doctors were also subpoenaed by the Justice Department for patents’ private information. By August, 16 states sued the administration to fight the restrictions.

The Supreme Court weighed in on the debate in June, ruling that states can control who receives care. The Trump administration has also banned transgender people in the military.

At the press conference, Kennedy said this was a step to protect kids from what he called sex-rejecting procedures, like surgeries and puberty blockers. Fewer than 3% of American youth identify as transgender or nonbinary, and most do not seek out medical care.

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