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The Trump administration has reaffirmed its pursuit of a sweeping Medicare funding block on providers of pediatric gender-affirming care in response to a report that it planned to abandon the attempt, which has faced hurdles in court. The HHS gender-affirming care rule dispute centers on whether the administration will finalize a proposal first unveiled in December.
What the HHS Gender-Affirming Care Rule Would Do
The Department of Health and Human Services and its Centers for Medicare and Medicaid Services, in December, unveiled a proposed rule that would add a ban on some of these services for minors, specifically those involving pharmaceutical or surgical interventions, as a condition of participation in Medicare and Medicaid programs. Nearly all of the country’s hospitals participate in the government programs and rely on them as a substantial portion of their revenue.
Legal Challenges From State Attorneys General
The proposed rule was challenged by 21 state attorneys general who argued that the policy change would supersede their ability to regulate providers, and in the subsequent months secured an order from an Oregon federal judge enjoining CMS from implementing its proposal. This injunction has kept the HHS gender-affirming care rule from taking effect while litigation continues.
Conflicting Reports on the Rule’s Status
The Office of Management and Budget’s website shows that the final version of that proposal has been under review by the agency since June 16. The administration, as recently as late June, has petitioned the court to amend its judgment. On Monday, however, NPR reported that it had obtained “an official document” indicating that HHS no longer planned to finalize the proposed rule, though it also had not formally withdrawn the proposal.
HHS Pushes Back on the Report
While the NPR report cited an on-the-record statement from CMS declining to comment on future rulemaking, HHS took a more concrete stance late Tuesday morning by describing the report’s claims as “completely inaccurate and unfounded.” “The Department has not withdrawn or reversed course on the [proposed gender-affirming care] rule,” an HHS social media account wrote on X. “HHS and CMS continue to follow statutory requirements by reviewing comments, and we intend to issue a final rule. HHS remains committed to protecting children from potentially lifelong, irreversible, and harmful sex-rejecting interventions.”
Background Behind the HHS Gender-Affirming Care Rule
In line with an executive order from the president early in his second term, HHS spent much of last year laying the groundwork for its proposed rule with information requests, warning notices, and a literature review in which authors concluded there was limited known benefit but substantial risks involved with pediatric gender-affirming care.
Medical Groups Largely Disagree
Most medical professional groups largely disagree with that stance, including the American Academy of Pediatrics, the American Medical Association, and the American Psychological Association. This disagreement between HHS’s internal review and mainstream medical organizations remains a central point of contention surrounding the HHS gender-affirming care rule.
Impact on Hospitals and Providers
The scrutiny has led to at least dozens of hospitals and other pediatric providers suspending or shuttering their gender-affirming care programs. Others, who were subject to False Claims Act investigations by other wings of the executive branch, have signed commitments with the government to halt the services and devote funds toward those seeking to reverse their prior procedures.
Judicial Pushback on Related Enforcement Efforts
Several judges have pushed back on law enforcement’s efforts to subpoena records from hospitals regarding previously delivered services and patients. This judicial resistance suggests the broader enforcement campaign accompanying the HHS gender-affirming care rule has faced legal friction beyond the rule itself.
A Related FTC Case Against WPATH
The Federal Trade Commission also recently sued a prominent nonprofit gender dysphoria professional organization, the World Professional Association for Transgender Health, over allegedly mischaracterizing medical evidence that supports its guidelines for pediatric gender-affirming care, an effort that already scored an early courtroom win over WPATH’s motion to dismiss.
What This Means Going Forward
With the HHS gender-affirming care rule still under OMB review, an active federal injunction in place, and HHS publicly denying any retreat from the policy, the rule’s ultimate fate remains tied to ongoing litigation. Hospitals reliant on Medicare and Medicaid funding will likely continue watching closely for how the Oregon court proceedings and the administration’s amended judgment petition unfold in the coming months.
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