The Centers for Medicare & Medicaid Services is ending the use of Medicaid and Children’s Health Insurance Program funds to pay for transition-related services and procedures for transgender youth. CMS said it is implementing the final rule to protect children from experimental and life-altering, sex-rejecting procedures that carry serious long-term health risks and lack sufficiently reliable evidence of clinical benefit.
Prohibited Procedures
Prohibited procedures on children include puberty blockers, cross-sex hormones and surgical operations. “These can result in irreversible damage, including infertility, impaired sexual function, diminished bone density, altered brain development and other lasting physiological effects,” CMS said.
The final rule is scheduled to take effect Oct. 13. Federal Medicaid and Children’s Health Insurance Program funding will be available for a tapering-off period of up to six months from the effective date of the final rule for children currently on hormone therapy.
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Coverage of Mental Health Services
The rule does not affect the coverage of mental health services, CMS said. Children’s Health Insurance Program is required to cover mental health services in accordance with federal law. Medicaid’s Early and Periodic Screening, Diagnostic and Treatment provisions will continue to cover mental health services for eligible children.
CMS said its decision follows a review of national and international research by the Department of Health and Human Services that identified significant evidence gaps, documented serious safety concerns, and concluded that the evidence supporting these interventions for children remains insufficient to justify federal taxpayer funding.
Professional organizations, including the American Society of Plastic Surgeons, have clarified their positions on these interventions, CMS said. In February, the American Society of Plastic Surgeons issued a position statement on gender surgery for children and adolescents that said, “ASPS recommends that surgeons delay gender-related breast/chest, genital, and facial surgery until a patient is at least 19 years old.”
The American Society of Plastic Surgeons said it concluded there was “insufficient evidence demonstrating a favorable risk-benefit ratio for the pathway of gender-related endocrine and surgical interventions in children and adolescents.” It cited two heavily debated publications on the topic, the Cass Review by a senior doctor in England and a 2025 report issued by HHS.
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Reaction to the Rule
CMS also pointed to the Cass report in its final rule, and actions taken by other countries and states in the U.S. that have moved to restrict these procedures for minors. The proposed rule, issued in December 2025 as a Hospital Condition of Participation in Medicare and Medicaid, received pushback from the American Hospital Association and other groups.
In February, the AHA wrote to CMS Administrator Dr. Mehmet Oz, first clarifying that it wasn’t taking a position on the proposed rule’s procedures for minors, as the organization does not provide clinical guidance. The AHA objected to CMS expanding the conditions of participation to forbid particular treatments for diagnoses.
Advocates for Trans Equality and its coalition partners organized a campaign to submit nearly 35,000 comments to oppose the rule. “This CMS rule is an openly discriminatory attack without any credible medical or financial basis,” said A4TE Health Policy Analyst SMK.
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The decision may have broader implications for the healthcare system, as it reflects a shift in the way that medical interventions are evaluated and funded. The use of federal healthcare programs to support treatments is a complex issue, and one that requires careful consideration of the available evidence.
Healthcare providers and advocates will likely closely watch the rule, as it has the potential to impact the lives of many young people.
As the situation continues to evolve, it will be important to monitor the effects of the rule.