Trump administration aims to stop hospitals from offering gender-affirming care: Questions & Answers

President Trump’s administration has made it clear that it doesn’t want hospitals and health systems to offer gender-affirming care to minors, but now the federal government has taken it a step farther.

The U.S. Department of Health & Human Services announced new regulatory steps Thursday to block such care in hospitals.

Here’s a rundown of the government’s plans.

Q: What is the government proposing?

A: The Health Department is introducing new regulations aimed at barring hospitals from providing gender-affirming care to those under 18.

Q: What measures are being proposed?

A: The Health Department says it will introduce new regulations that tie gender-affirming care to participation in Medicare and Medicaid programs. In short, if hospitals and health systems want funding from Medicare and Medicaid, they won’t be able to provide gender-affirming care, according to the health department.

The government is also planning to prohibit Medicaid funding for sex-rejecting procedures on children under 18. The federal Children’s Health Insurance Program wouldn’t fund such procedures on individuals under the age of 19.

Today, 27 states refuse to provide Medicaid coverage of “sex-rejecting procedures” on children, the health department says.

Shortly after his inauguration in January, Trump issued an executive order barring gender-affirming care for minors. The Health Department said the actions are designed to carry out Trump’s executive order.

Q: How many hospitals would be affected?

A: Virtually all of America’s hospitals and health systems receive funding from Medicare and Medicaid.

Q: What type of services would be blocked?

A: The government is looking to prohibit surgical operations, but the regulations go beyond surgery. Other “procedures” on children that would be barred include the use of puberty blockers and cross-sex hormones.

Q: What is the government’s rationale?

A: Dr. Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services, says the procedures “carry life-altering risks with no reliable evidence of benefit.”

“This proposal seeks to clarify that hospitals participating in our programs cannot conduct these unproven procedures on children,” Oz said in a statement. “CMS will ensure that federal program standards reflect our responsibility to promote the health and safety of children.”

When asked about mental health services for children at a press conference touting the proposed rules, Oz said, “We have mental healthcare services available. Our challenge, as you know, is not enough practitioners.”

At the news conference, HHS Secretary Robert F. Kennedy Jr. said, "So-called gender-affirming care has inflicted lasting physical and psychological damage on vulnerable young people. This is not medicine, it is malpractice.”

Q: What are hospitals saying?

A: The American Hospital Association says it’s evaluating the government’s plans.

“The AHA is reviewing the proposed rules and intends to provide comments to the agency at the appropriate time,” an association spokesman said via email.

Q: What are pediatricians saying?

A: The American Academy of Pediatrics condemned the administration’s plans. Susan J. Kressly, MD, the group’s president, said the plans represent “a concerning departure from the longstanding principle that health care policy should be grounded in scientific evidence, clinical expertise, and the needs of children and families.”

“Allowing the government to determine which patient groups deserve care sets a dangerous precedent, and children and families will bear the consequences,” Kressy said in a statement.

“These rules are a baseless intrusion into the patient-physician relationship,” she said.

“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. The government’s actions today make that task harder, if not impossible, for families of gender-diverse and transgender youth.”

Q: How are other healthcare leaders reacting?

A: Dr. Jamila Perritt, president & CEO of Physicians for Reproductive Health responds, called the proposed rules “a deliberate and targeted attack on transgender youth, their families, and the clinicians committed to providing patients the care they need.”

“In an effort to strongarm hospitals into participating in the administration’s anti-LGBTQ agenda, the Trump Administration is forcing health care systems to choose between providing lifesaving care for LGBTQ+ young people and accepting crucial federal funding. This is a lose-lose situation where lives are inevitably on the line,” Perritt, an ob-gyn in Washington, D.C., said in a statement.

Jennifer Mensik Kennedy, president of the American Nurses Association, tells Chief Healthcare Executive® that she needs to review the government proposals, but she says she’d like to see decisions on gender-affirming care to stay between healthcare providers and families.

“Every patient is special and unique,” she says. “And having that relationship with the provider, with the nurse, to understand that person and what's going on in their life, that's important. Because there are so many nuances to any human and to any person and their story, that decision needs to remain between the provider and the patient.”

Q: Can the government do what it’s planning?

A: The Trump administration is clearly going to face a legal challenge.

The American Civil Liberties Union said it will sue to block the changes.

Chase Strangio, co-director of the ACLU’s LGBTQ & HIV Rights Project, called the administration’s proposals “cruel and unconstitutional.”

“By attempting to strip away essential healthcare, the administration is not 'protecting' anyone; it is weaponizing the federal government to target a vulnerable population for political gain,” Strangio said. “Healthcare decisions belong to families and their doctors, not politicians.”

The Supreme Court upheld a Tennessee state law barring minors from receiving gender-affirming care. Supporters and detractors both said the ruling would have lasting implications.

Q: What’s happening in Congress?

A: The House of Representatives passed a bill that would result in doctors facing criminal charges - and potentially years in prison - for providing gender-affirming care to minors.

The measures must also pass the Senate, and it’s unclear if that will happen.

In 24 states, doctors can face legal and professional consequences for offering gender-affirming care to minors, according to KFF.