On Thursday, September 28, 2023, the U.S. Department of Health and Human Services (HHS) proposed a set of regulations that would significantly restrict access to gender-affirming care for minors. This sweeping move is seen as a continuation of previous restrictions introduced during the Trump administration on transgender individuals. The proposed regulations aim to cut off federal funding through Medicaid and Medicare for hospitals that provide gender-affirming procedures including puberty blockers and hormone therapies to children.
Currently, more than half of U.S. states have some form of ban or restriction on gender-affirming care. Yet, the new proposals threaten to impact nearly two dozen states where such medical care still remains legal and funded by Medicaid and Medicare. These regulations, which are not finalized and will undergo a lengthy rulemaking process including public comments, could face significant legal hurdles.
The resulting impact on healthcare providers is concerning; in anticipation of such federal action, many hospitals have already begun to cease providing gender-affirming care for minors. Notably, the American Medical Association and other major medical organizations have publicly opposed these restrictions, advocating for the autonomy of families and healthcare providers in deciding the best course of action for minors experiencing gender dysphoria.
Gender-affirming care often begins with evaluations by a multidisciplinary team, which might lead to social transition for the individual. In some cases, young people may be prescribed puberty blockers followed by hormone therapies. Surgical interventions, however, are rarely pursued for minors. Presently, Medicaid in less than half of the states covers gender-affirming care, with at least 27 states having passed laws curtailing such services. Additionally, federal judges in states like Arkansas and Montana have ruled against such bans, labeling them as unconstitutional—a battle that is ongoing.
Rodrigo Heng-Lehtinen from The Trevor Project criticized the proposed changes, remarking that they represent a “one-size-fits-all mandate from the federal government” on healthcare decisions, which should ideally be determined collaboratively between patient and healthcare provider. As efforts to restrict access continue to escalate, many advocates express worry about the future of healthcare for transgender and nonbinary youth.
