Watch: The Trump administration seeks to block American children’s access to transgender health care

WASHINGTON (AP) — The U.S. Department of Health and Human Services on Thursday unveiled a series of regulatory actions designed to effectively ban gender-affirming care for minors, building on the Trump administration’s broader restrictions on transgender Americans.

The sweeping proposals — the most significant steps this administration has taken to date to restrict the use of puberty blockers, hormone therapy, and surgical interventions for transgender children — include cutting federal Medicaid and Medicare funding for hospitals that provide gender-affirming care to children and prohibiting the use of federal Medicaid funds to fund such procedures.

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“This is not medicine, this is malpractice,” Health Secretary Robert Kennedy Jr. said of gender confirmation procedures on children at a news conference Thursday. “Sex rejection procedures deprive children of their future.”

More than half of US states already prohibit or restrict gender-affirming care. But Thursday’s announcements would jeopardize access in nearly two dozen states where drug treatments and surgical procedures remain legal and are funded by Medicaid, which includes federal and state dollars.

Kennedy also announced Thursday that the Department of Health and Human Services’ Office for Civil Rights will propose a rule that would exclude gender dysphoria from the definition of disability. In a related move, the Food and Drug Administration issued warning letters to dozens of companies that market vests and other equipment used by people with gender dysphoria. Manufacturers include GenderBender LLC in Carson, California and TomboyX in Seattle. The FDA letters state that chest binders can only be legally marketed for FDA-approved medical uses, such as recovery after mastectomy surgery.

The proposals announced by Kennedy and his deputies are not final or legally binding. The federal government must go through a lengthy rulemaking process, including public comment periods and rewriting documents, before the restrictions become permanent. They are also likely to face legal challenges.

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But the proposed rules would likely make health care providers more fearful of providing gender-affirming care to children, and many hospitals have already halted such care in anticipation of federal action.

Nearly all U.S. hospitals participate in Medicare and Medicaid, the federal government’s largest health plans that cover elderly, disabled and low-income Americans. Losing the ability to access these payments would put most hospitals and medical providers in the United States at risk.

The same funding restrictions will apply to a smaller health program when it comes to caring for people under 19, the state’s Children’s Health Insurance Program, according to a federal notice published Thursday morning.

This approach contradicts the recommendations of most major US medical organizations, including the American Medical Association, which has urged states not to restrict care for people with gender dysphoria.

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These ads build on a wave of actions taken by President Donald Trump, his administration and Republicans in Congress to target transgender rights across the country.

On his first day in office, Trump signed an executive order declaring that the federal government would recognize only two fixed genders: male and female. He also signed orders aimed at cutting federal support for transgender people under 19 and banning transgender athletes from participating in girls’ and women’s sports.

On Wednesday, a bill that would expose transgender health care providers to prison if they treat people under the age of 18 passed the US House of Representatives and heads to the Senate. Another bill under consideration in the House on Thursday aims to ban Medicaid coverage of gender-affirming care for children.

Young people who consistently identify as a gender different from their assigned sex at birth are evaluated by a team of specialists. Some may try to make a social transition, including changing their hairstyle or pronouns. Some may later also receive hormone blocking medications that delay puberty, followed by testosterone or estrogen to bring about the patients’ desired physical changes. Surgery is rare for minors.

Medicaid programs in less than half of states currently cover gender affirming care. At least 27 states have adopted laws restricting or prohibiting care. Federal judges have struck down bans in Arkansas and Montana as unconstitutional. The legal battles in those states are still ongoing.

Advocates for transgender children have strongly refuted the administration’s claims about gender-affirming care and said Thursday’s moves would put people’s lives at risk.

“In an effort to push hospitals to buy into the administration’s anti-LGBTQ agenda, the Trump administration is forcing health care systems to choose between providing life-saving care to LGBT youth and accepting critical federal funding,” Dr. Jamila Perrette, a Washington-based obstetrician-gynecologist and president and CEO of Physicians for Reproductive Health, said in a statement. “This is a lose-lose situation where lives are inevitably at stake.”

Rodrigo Heing-Lehtinen, a senior vice president at The Trevor Project, called the changes a “one-size-fits-all mandate from the federal government” on what the decision should be between doctor and patient. “The numerous efforts we are seeing from federal lawmakers to strip transgender and nonbinary youth of the health care they need is deeply troubling,” he said.

Shastri reported from Milwaukee. Associated Press writer Jeff Mulvihill contributed to this report.