The US Department of Health and Human Services (HHS) has announced a series of proposed regulatory actions to implement President Trump’s Executive Order aimed at ending the practice of sex-rejecting procedures on children. According to the HHS, these procedures, which include pharmaceutical or surgical interventions intended to align a child’s physical appearance or body with an asserted identity different from their sex, can expose young people to irreversible harm.
The Centres for Medicare & Medicaid Services (CMS) will release a notice of proposed rulemaking to bar hospitals from performing these procedures on children under the age of 18 as a condition of participation in Medicare and Medicaid programs. Nearly all US hospitals participate in these programs, and the action is intended to ensure the federal government does not contract with organizations that inflict permanent harm on children.
The proposed rule is based on the authority granted to CMS under sections 1861(e)(9), 1871, and 1905(a) of the Social Security Act, which allow the agency to establish standards to protect patient health and safety in Medicare- and Medicaid-participating hospitals. Additionally, CMS will issue a notice of proposed rulemaking to prohibit federal Medicaid funding for sex-rejecting procedures on children under 18, and for Children’s Health Insurance Program (CHIP) funding on individuals under 19.
Currently, 27 states do not provide Medicaid coverage for these procedures, which can cause irreversible damage, including infertility, impaired sexual function, diminished bone density, altered brain development, and other lasting physiological effects. Health and Human Services Secretary Robert F. Kennedy, Jr. stated that these procedures “do not meet professionally recognized standards of healthcare.”
The US Food and Drug Administration (FDA) is also issuing warning letters to 12 manufacturers and retailers for illegal marketing of breast binders to children for gender dysphoria. Furthermore, HHS is moving to reverse the Biden administration’s attempt to include gender dysphoria in the definition of a disability.
The proposed regulatory actions have been met with support from healthcare professionals, who emphasize the importance of protecting children from experimental interventions that carry life-altering risks with no reliable evidence of benefit. The HHS has highlighted that nearly 14,000 minors received sex-rejecting procedures between 2019 and 2023, according to claims data, and its peer-reviewed study, Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices, highlights the medical dangers posed by these interventions.
The proposed regulations aim to ensure that federal program standards reflect the responsibility to promote the health and safety of children, and to prevent the federal government from contracting with organizations that inflict permanent harm on children. The actions mark a significant development in the ongoing debate surrounding the treatment of gender dysphoria in minors, and are expected to have far-reaching implications for healthcare providers, policymakers, and families across the United States.
