Trump administration seeks to ban funding for hospitals offering ‘sex-rejecting’ care for minors

The Department of Health and Human Services moved Thursday to cut off Medicare and Medicaid funding to hospitals treating minors with sex-transition drugs and surgeries, part of a newly unveiled regulatory campaign against providers of “gender-affirming care” for children.

The Center for Medicare & Medicaid Services said its proposed rulemaking would prevent hospitals from performing “sex-rejecting procedures on children under 18” as a condition for participation in the program, citing its authority to protect patient health and safety under the Social Security Act.

“Nearly all U.S. hospitals participate in Medicare and Medicaid, and this action is designed to ensure that the U.S. government will not be in business with organizations that intentionally or unintentionally inflict permanent harm on children,” the department said Thursday in a statement.

The proposed rule would also apply to funding for individuals under the age of 19 under the federal Children’s Health Insurance Program.

“Children deserve our protection, not experimental interventions performed on them that carry life-altering risks with no reliable evidence of benefit,” CMS Administrator Mehmet Oz said. “This proposal seeks to clarify that hospitals participating in our programs cannot conduct these unproven procedures on children.”

The Food and Drug Administration said it will issue warning letters to 12 manufacturers and retailers marketing “breast binders” as medical devices for children undergoing gender transitions, and seek to reverse the Biden administration’s effort to classify gender dysphoria as a federally recognized disability.

The flurry of regulatory activity comes with more than 20 hospitals already abandoning or restricting their pediatric gender-transition practices following President Trump’s executive order banning federal funds from supporting the “chemical and surgical mutilation” of children.

Last month, the department released a peer-reviewed review of the evidence discrediting “pediatric sex-rejecting procedures,” challenging the positions of major U.S. medical associations, including the American Academy of Pediatrics.

Critics have accused the Trump administration of interfering with the doctor-patient relationship and undermining parental rights, while the department countered that parents have been misinformed about the risks and long-term impacts of such treatments.

“Sex-rejecting procedures on children — which include puberty blockers, cross-sex hormones, and surgical operations — cause irreversible damage, including infertility, impaired sexual function, diminished bone density, altered brain development, and other irreversible physiological effects,” the department said Thursday.

The report, “Treatment for Pediatric Gender Dysphoria: A Review of Evidence and Best Practices,” said claims data show that nearly 14,000 minors underwent gender-transition treatment between 2019-23.

Health and Human Services Secretary Robert F. Kennedy Jr. signed on Thursday a declaration saying that pediatric sex-change treatments such as puberty blockers, cross-sex hormones and surgeries “do not meet professionally recognized standards of health care.”

Medical professionals who provide such treatment on minors “would be deemed out of compliance with those standards,” the department said.

Assistant Secretary for Health Brian Christine also signed a public-health message on Thursday saying that the “current evidence does not support claims that puberty blockers, cross-sex hormones, and surgeries are safe and effective treatments for pediatric gender dysphoria.”

The FDA said “breast binders” are Class 1 medical devices used for purposes including recovery from breast-cancer surgery, and that marketing them to children as a treatment for gender dysphoria represents a “significant regulatory violation.”

The HHS Office for Civil Rights issued a proposed revision to Section 504 of the Rehabilitation Act of 1973 clarifying that “disability” excludes gender dysphoria, unless it results from a physical impairment.

“This clarification is necessary to resolve an ambiguity that the Biden administration introduced in the preamble to the Section 504 regulations that they issued in 2024,” said an administration official on background. “We’re taking this action to ensure that HHS funding recipients comply with the best reading of the plain language of 504.”

The sweeping regulatory measures come a day after the House voted 216-211 to pass a bill criminalizing gender-transition drugs and surgeries for minors sponsored by Rep. Marjorie Taylor Greene, Georgia Republican.

The bill is considered dead on arrival in the Senate, where it would need at least seven Democratic votes to pass. Ms. Greene plans to leave office Jan. 5.

Meanwhile, HHS’ two proposed rulemaking proposals won’t be approved without a fight.

The American Civil Liberties Union said Thursday that it will challenge “Trump’s unconstitutional effort to ban gender-affirming care for transgender youth.”

“These gratuitous proposals are cruel and unconstitutional attacks on the rights of transgender youth and their families,” said Chase Strangio, co-director of the ACLU’s LGBTQ & HIV Rights Project. “By attempting to strip away essential health care, the administration is not ’protecting’ anyone; it is weaponizing the federal government to target a vulnerable population for political gain.”

The proposals would “force doctors to choose between their ethical obligations to their patients and the threat of losing federal funding,” said Mr. Strangio, who became last year the first openly transgender person to argue a case before the Supreme Court.

Those praising the department’s actions include Stanley Goldfarb, a medical doctor and the chairman of Do No Harm, saying it “marks a major step toward delivering a crippling blow to the child transgender industry.”

“Many so-called gender clinics have already begun to close as the truth about the risks and long-term harms about these drugs and surgeries on minors have been exposed,” Dr. Goldfarb said in a statement. “Now, hospitals that receive taxpayer funds from these federal programs must follow suit.”