Trump administration moves to cut off transgender care for children
[December 19, 2025]
By ALI SWENSON, MATTHEW PERRONE and DEVI SHASTRI
WASHINGTON (AP) — The U.S. Department of Health and Human Services on
Thursday unveiled a series of regulatory actions designed to block
access to gender-affirming care for minors, building on broader Trump
administration restrictions targeting transgender Americans.
The sweeping proposals — the most significant moves this administration
has taken so far to restrict the use of puberty blockers, hormone
therapy and surgical interventions for transgender children — 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.”
Thursday’s announcements would imperil access in nearly two dozen states
where drug treatments and surgical procedures remain legal and covered
by Medicaid, which is funded by federal and state dollars.
The proposals run counter to the recommendations of major U.S. medical
societies. And advocates for transgender children strongly refuted the
administration’s claims about gender-affirming care, saying Thursday’s
moves would put lives at risk.
“The multitude of efforts we are seeing from federal legislators to
strip transgender and nonbinary youth of the health care they need is
deeply troubling,” said Rodrigo Heng-Lehtinen, of The Trevor Project, a
nonprofit suicide prevention organization for LBGTQ+ youth.
Proposed rules would threaten youth gender-affirming care in states
where it remains legal
Medicaid programs in slightly less than half of states currently cover
gender-affirming care. At least 27 states have adopted laws restricting
or banning the care. The Supreme Court’s recent decision upholding
Tennessee’s ban means most other state laws are likely to remain in
place.
The proposals announced by Kennedy and his deputies are not final or
legally binding. Officials must go through a lengthy rulemaking process,
including periods of public comment and document rewrites, before the
restrictions become permanent. They are also likely to face legal
challenges.
But the proposed rules will likely further discourage health care
providers from offering gender-affirming care to children and many
hospitals have already ceased such care in anticipation of federal
action.
Hannah Edwards, executive director of Transforming Families, a support
organization for families of transgender youth in Minnesota, said she
expects some patients will still be able to get care at private clinics
that don't participate in Medicaid and Medicare.
But that won’t be a solution for all kids seeking care.
Edwards has a 15-year-old transgender daughter and said that there’s a
growing sense of fear because of federal government actions, even in a
state that’s become a destination for families with transgender
children.
“The conversation that constantly happens for my family personally is:
Where is our red line when we need to flee the country?” she said.
Nearly all U.S. hospitals care for patients enrolled in Medicare and
Medicaid, the federal government's largest health plans that cover
seniors, people with disabilities and low-income Americans. Losing
access to those payments would imperil most U.S. hospitals and medical
providers.
The same funding restrictions would apply to a smaller health plan, the
State Children’s Health Insurance Program, when it comes to care for
people under the age of 19, according to a federal notice posted
Thursday morning.
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 “This sets a very dangerous
precedent for all areas of health care, if the government can
cherry-pick one area of medicine to use to withhold necessary
funding from entire groups of people,” said Dr. Scott Leibowitz, a
psychiatrist and board member for the World Professional Association
for Transgender Health. The group develops standards of care for
transgender patients globally.
Kennedy also announced Thursday that the HHS Office
of Civil Rights will propose a rule excluding gender dysphoria from
the definition of a disability. Gender dysphoria is a formal medical
diagnosis that describes the distress felt when someone’s gender
expression does not match their sex assigned at birth.
Young people who persistently experience gender dysphoria are first
evaluated by a team of professionals. Some may try a social
transition, involving changing a hairstyle or pronouns. Some may
later also receive hormone-blocking drugs that delay puberty,
followed by testosterone or estrogen to bring about the desired
physical changes sought by patients. Surgery is rare for minors.
Moves contradict advice from medical organizations and
transgender advocates
Dr. Mehmet Oz, the administrator of the Centers for Medicare and
Medicaid Services, on Thursday called transgender treatments “a
Band-Aid on a much deeper pathology,” and suggested children with
gender dysphoria are “confused, lost and need help.”
Polling shows many Americans agree with the administration’s view.
An Associated Press-NORC Center for Public Affairs Research survey
conducted in May found that about half of U.S. adults approved of
how Trump was handling transgender issues.
Chloe Cole, a conservative activist known for speaking about her
gender-transition reversal, spoke at the news conference to express
appreciation. She said cries for help from her and others in her
situation, “have finally been heard.”
But the approach contradicts the recommendations of most major U.S.
medical organizations, including the American Medical Association,
which has urged states not to restrict transgender care and
services. The American Academy of Pediatrics called on HHS to
reverse course Thursday, saying “children and families will bear the
consequences.”
“These rules are a baseless intrusion into the patient-physician
relationship. Patients, their families, and their physicians—not
politicians or government officials —should be the ones to make
decisions together about what care is best for them,” said Dr. Susan
Kressly, AAP president.
Actions build on a larger effort to restrict transgender rights
The announcements build on a wave of actions President Donald Trump,
his administration and Republicans in Congress have taken to target
the rights of transgender people nationwide.
On his first day in office, Trump signed an executive order that
declared the federal government would recognize only two immutable
sexes: male and female. He also has signed orders barring
transgender athletes from participating in girls’ and women’s sports
and cutting federal spending for transition-related care, which
prompted Thursday's announcement.
On Wednesday, a bill that would open transgender health care
providers to prison time if they treat people under the age of 18
passed the U.S. House and heads to the Senate. On Thursday, House
lawmakers passed a different bill intended to ban Medicaid coverage
for gender-affirming care for children.
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Shastri reported from Milwaukee. Associated Press writer Geoff
Mulvihill contributed to this report
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