President Donald Trump declared that federal Medicaid funds would cease covering gender-affirming surgeries and hormone treatments for transgender minors. This move raises questions about continued access to such care in states with protections for transgender youth. Trump’s decision is part of his broader strategy to limit protections for trans youth, already evident in policies that restrict transgender students’ participation in school sports. Republican-led states have also banned transgender athletes from competing on teams matching their gender identity.
Although states that protect gender-affirming care may still allow providers to offer treatment, they could rely on state funding to cover services. Trump announced the policy shift via Truth Social, stating, “Today, at my direction, Dr. Mehmet Oz announced that Medicaid will NO LONGER fund gender transition surgeries and hormones for minors.” He described these as “barbaric surgeries and practices” that the policy aims to protect children from.
The Centers for Medicare & Medicaid Services (CMS) affirmed that the new rule would end federal Medicaid funding for such treatments for minors, with the Children’s Health Insurance Program (CHIP) also barred from covering those procedures for individuals under 19. The policy is set to become effective in October.
State Differences in Protecting Access
A Kaiser Family Foundation policy tracker illustrates a deeply divided national landscape. As of May, 27 states have imposed laws or policies limiting youth access to gender-affirming care, leaving the rest without such restrictions. KFF estimates that approximately half of transgender youth aged 13 to 17 reside in states with restricted care.
The West Coast and Northeast states, including California, Oregon, Washington, Colorado, Minnesota, Illinois, New York, Massachusetts, and others, have adopted “shield” laws or policies that protect providers and patients seeking legally permitted care. Trump’s Medicaid action may impact families in these states, as federal funding plays a crucial role in state Medicaid programs, potentially creating new coverage obstacles for lower-income families.
Why Nationwide Care Doesn’t End
KFF’s tracker shows that restrictions on gender-affirming care remain state-governed. While some states prohibit treatments like puberty blockers or hormone therapy for minors, others expressly protect access. Legal challenges persist nationwide, with KFF noting that 18 states face courtroom disputes over youth gender-affirming care restrictions.
The Supreme Court’s 2025 decision in United States v. Skrmetti upheld Tennessee’s ban on gender-affirming care for minors, granting states more authority to maintain such restrictions. However, this ruling does not mandate states to ban care, resulting in a patchwork of divergent policies across the nation.
Perspectives on the Policy
The Trump administration asserts that the change aims to shield children from treatments they believe could cause irreversible harm. Health and Human Services Secretary Robert F. Kennedy Jr. noted that Medicaid and CHIP funds will no longer support procedures that “fail to meet the evidentiary standard our children deserve.” CMS Administrator Dr. Oz stated the rule aligns with “following the science” and safeguarding children.
Conversely, LGBTQ+ advocates criticize the move. Kelley Robinson, Human Rights Campaign President, argued the rule disrupts medical decisions made by families and doctors. Major medical organizations, including the American Medical Association and American Academy of Pediatrics, continue supporting access to gender-affirming care under established clinical guidelines.
While Trump’s announcement aligns with the new policy, gender-affirming care is not eliminated nationwide. Access remains reliant on state laws, with many states actively maintaining protections for transgender youth and the healthcare providers serving them.