Medicaid and CHIP Will Stop Paying for Gender-Affirming Care for Minors, With Hormone Coverage Phased Out by April 2027

The Trump administration said Tuesday that Medicaid will stop paying for gender-affirming surgeries and hormone treatments for transgender minors, and that the Children's Health Insurance Program will not cover the treatments for anyone under 19.

Under the policy, Medicaid and CHIP will continue to pay for mental health treatment for transgender minors. Coverage of hormone treatments — used both to block puberty and to produce sex-related physical changes — will be phased out for patients already receiving them as of April 2027. President Trump said in a social media post Tuesday that he directed Dr. Mehmet Oz, the administrator of the Centers for Medicare and Medicaid Services, to make the change. "We are not going to pay for our innocent children to undergo these barbaric surgeries and practices, which result in unthinkable and irreversible harm to their young bodies," Trump wrote. CMS did not respond to questions about the policy on Tuesday, and it is not clear how much federal money currently covers such treatments.

The practical reach of the rule is narrower than the rhetoric around it. At least 27 states have already banned gender-affirming care for people under 18, and many large hospitals in states without bans have stopped offering some treatments regardless. Surgeries on minors are rare; puberty blockers and hormone therapy are the far more common interventions, and they are the ones the phase-out targets.

Legal challenges were promised within hours. Josh Rovenger, legal director at GLBTQ Legal Advocates and Defenders, said the rule "is putting up barriers between parents and their ability to make the best medical decisions for their children." Human Rights Campaign President Kelley Robinson said in a statement that "the Trump administration is terrorizing trans youth and their families with these kinds of actions, and it has to stop." HRC is already suing the administration over an effort to bar gender-affirming care coverage under federal employee benefit plans.

The medical establishment is not uniformly aligned. The American Medical Association and most other major medical organizations support access to gender-affirming care. But the American Society of Plastic Surgeons said earlier this year that it found "insufficient evidence" that the benefits of chest, genital and facial surgeries on minors experiencing gender dysphoria outweigh the risks.

Tuesday's announcement is the latest in a sequence that began the day Trump returned to office last year. The administration has already moved to cut off Medicaid and Medicare funding to hospitals that provide gender-affirming care to minors, barred transgender athletes from girls' and women's sports competitions, ended the option to select male, female or X as a sex designation on passports, and released a report urging therapy alone rather than broader gender-affirming health care for transgender youth. Most of those changes drew lawsuits. The Supreme Court has allowed the passport policy to stand and permitted states to enforce sports bans; a lower court ruled against the administration's formal declaration that the treatments are unsafe and ineffective; and the challenge to the hospital funding policy is still pending.