On January 28, 2025, President Trump issued Executive Order 14187 (Protecting Children from Chemical and Surgical Mutilation), directing federal agencies to cut off federal funding and support for gender-affirming care for people under age 19, including puberty blockers, hormone therapy, and gender-affirming surgery.

On December 18, 2025, health officials from the Trump administration announced several additional policy changes that, if finalized, will have the effect of essentially banning gender-affirming care for transgender young people, even in states where it remains legal.

One rule would prohibit Medicaid from covering any medical care provided to transgender patients younger than age 18 and prohibit reimbursement though CHIP (Children’s Health Insurance Program) for gender-affirming care for patients under 19.

Additionally, all Medicare and Medicaid funding would be blocked for any services at hospitals that provide pediatric gender-affirming care. This means that hospitals and doctors that perform gender-affirming care on minors will have to forgo federal Medicare and Medicaid funding under the new proposed rules. Virtually every hospital in the country relies on this funding, so the rule would have a wide-ranging impact and could likely make gender-affirming care inaccessible nationwide.

The proposed rules would exclude gender dysphoria not caused by physical impairment from civil-rights health care protections, reducing legal safeguards against discrimination in medical care.

This multi-pronged plan from DHS is part of the Trump Administration’s efforts to limit gender-affirming care, and if finalized, could have a profound impact on care delivery for transgender and gender non-conforming individuals.