PHILADELPHIA — President Donald Trump’s administration proposed a sweeping set of rules Thursday designed to prevent hospitals from providing gender-affirming care to minors, a move that could have consequential implications for the Children’s Hospital of Philadelphia

CHOP runs one of the nation’s largest clinics providing medical care and mental health support for transgender and gender-nonbinary children and teens and their families. Each year, hundreds of new families seek care at CHOP’s Gender and Sexuality Development Program, created in 2014. The information of CHOP patients who have sought gender-affirming care had been the target of a recent unsuccessful lawsuit from the Trump administration.

The proposals constitute the most significant moves this administration has taken to restrict the use of puberty blockers, hormone therapy and surgical interventions for transgender people under the age of 18 — include cutting off federal Medicaid and Medicare funding from hospitals that provide gender-affirming care to children and prohibiting federal Medicaid dollars from being used to fund such procedures.

“This is not medicine, it is malpractice,” Health Secretary Robert F. Kennedy Jr. said of gender-affirming procedures in a news conference on Thursday. “Sex-rejecting procedures rob children of their futures.”

CHOP, like most other hospitals in the country, participates in Medicare and Medicaid.

CHOP declined to comment on Thursday.

The renowned pediatric hospital treats children and teens with gender dysphoria — a medical condition in which a person’s body does not match their gender identity. Its doctors prescribe hormone therapy and puberty blockers.

The American Academy of Pediatrics and other major medical associations, citing research, widely accept such medications as safe, effective, and medically necessary for the patients’ mental health.

CHOP has said its doctors do not prescribe any medication before its patients undergo extensive medical and psychological evaluations.

Gender-affirming care is legal in Pennsylvania, and states, not the federal government, regulate medicine and doctors.

But Trump has sought to criminalize this care for minors, saying doctors are engaged in “chemical mutilation,” akin to child abuse, and has called the research “junk science.”

Just days into his second term in office, the president issued an executive order titled “Protecting Children from Chemical and Surgical Mutilation,” which contains inflammatory and misleading descriptions of largely medically approved transgender care. Kennedy has followed the president’s lead, signing a declaration Thursday refuting these procedures.

Other rules proposed Thursday include the U.S. Food and Drug Administration issuing warning letters to 12 manufacturers and retailers for what a HHS news release claims to be “illegal marketing of breast binders to children for the purposes of treating gender dysphoria.”

In June, the U.S. Department of Justice issued subpoenas to CHOP and at least 19 other hospitals that treat transgender youth as part of an investigation into possible health care fraud. The federal subpoenas demanded patient medical records, including their dates of birth, Social Security numbers and addresses, as well as every communication by doctors — emails, voicemails and encrypted text messages — dating back to January 2020.

The subpoenas touched off a wave of legal battles that continue to play out. Several hospitals around the country, including CHOP, filed motions asking federal judges to block the release of private patient information.

So far, federal judges in Philadelphia, Boston and Washington State have sided with hospitals, ruling the subpoenas were politically motivated.

In Philadelphia, U.S. District Court Judge Mark A. Kearney last month determined the “privacy interests of children and their families substantially outweighs the department’s need to know” such confidential and sensitive information. The federal government has 60 days to appeal the Nov. 21 ruling.

In September, patients and their parents joined the legal fight to limit the scope of the subpoenas issued to CHOP and the Children’s Hospital in Pittsburgh. The Philadelphia-based Public Interest Law Center, or PILC, filed separate but similar legal relief on behalf of families with children and teens who’ve received gender-affirming care at CHOP and in Pittsburgh.

The federal judge presiding over the Pittsburgh hospital’s case has yet to issue a ruling. Earlier this week, however, DOJ lawyers said they are willing to accept redacted medical records. They argued that would solve the dispute over patient privacy rights.

On Thursday, Mimi McKenzie, PILC’s legal director, said the center “strongly disagrees,” and it would fight the release of redacted medical records.

“These records are so deeply personal and contain such highly sensitive information about these young patients,” McKenzie said. “There is no anonymization or redaction that can protect their privacy interests.”

McKenzie said the proposed federal rule to ban all federal funding to hospitals that treat transgender youth would “face a myriad of legal challenges.” She described gender-affirming care as “lifesaving” for many children.

“The notion that our federal government would tell hospitals to pick which children you want to save — the children who need gender-affirming care or all the other children — is despicable. The cruelty of this administration knows no bounds.”

Other institutions have recoiled in the face of the Trump administration’s threats.

Earlier this year, Penn Medicine and Penn State Health cut back gender-affirming care for youth. Nemours Children’s Hospital in Delaware and UPMC Children’s Hospital in Pittsburgh announced they will no longer provide gender-affirming care beyond behavioral health services to new patients.

All cited fear of federal funding cuts.

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