On December 18, 2025, the US Department of Health and Human Services (HHS) unveiled several actions targeting gender-affirming care (GAC), including the use of puberty blockers, hormone therapy, and surgical interventions to treat gender dysphoria in minors.

The Centers for Medicare & Medicaid Services (CMS) issued two proposed rules, Prohibition on Federal Medicaid and Children’s Health Insurance Program (CHIP) Funding for Sex-Rejecting Procedures Furnished to Children and Hospital Condition of Participation: Prohibiting Sex Rejecting Procedures for Children, that would eliminate federal Medicaid funding for GAC services for minors and place hospital participation in Medicaid or Medicare at risk if they perform these services. The HHS Office of Civil Rights (OCR) also proposed a rule, Nondiscrimination on the Basis of Disability in Programs or Activities Receiving Federal Financial Assistance, which would clarify that individuals with certain gender identity disorders are not protected by the disability discrimination rules issued pursuant to Section 504 of the Rehabilitation Act.

Following the release of these rules, HHS issued a declaration that GAC services for children and adolescents are neither safe nor effective as treatment for gender dysphoria, gender incongruence, or other related disorders and, therefore, fail to meet professionally recognized standards of healthcare. Concurrently, the US Food and Drug Administration (FDA) issued warning letters to 12 companies for marketing chest binders as treatment for gender dysphoria in minors.

HHS’s actions stem from a January 2025 executive order (EO) from the Trump administration that directed HHS, the US Department of Justice, and other agencies to begin reviewing and promulgating specific actions to eliminate GAC for individuals under the age of 19. These actions represent a significant escalation of the Trump administration’s efforts against the provision of GAC to minors, and state attorneys general and advocacy groups have already signaled an intent to challenge these actions in federal court.

State attorneys general and advocacy groups have succeeded to date in preventing HHS from enforcing key aspects of the EO. PFLAG v. Trump and Washington v. Trump have temporarily blocked Section 4 of the EO, and the federal judge in PFLAG prohibited federal agencies from “conditioning, withholding, or terminating federal funds . . . based on the fact that a healthcare entity or health professional provides gender-affirming medical care to a patient under the age of 19.”

These injunctions are currently under appeal. HHS does not believe that these lawsuits prevent it from taking any of the actions announced on December 18, 2025. HHS states that it based these actions on Section 5 of the EO, which is not subject to any injunction. Section 5 of the EO directs HHS to take steps to eliminate GAC for minors, such as through Medicare or Medicaid conditions of participation or conditions of coverage, thereby allowing the rules to proceed through notice and comment rulemaking.

The proposed rules cite additional Trump administration actions regarding GAC for minors as support, including an HHS report reviewing best practices for pediatric gender dysphoria treatment, a state Medicaid director letter alerting states to CMS’s concerns about GAC, and a safety special alert memo for hospitals. A press release for the proposed rules is available here. Comments on the proposed rules are due February 17, 2026. The HHS declaration and FDA warning letters do not provide an opportunity for comment.

HHS’s actions follow the passage of two bills in the US House of Representatives on December 17, 2025, and December 18, 2025, that would criminalize the provision of GAC to minors and deny federal Medicaid funding for these services, respectively. Both bills now move to the US Senate, where passage is less likely. Taken together, HHS’s actions and the House passage of these bills demonstrate continued regulatory and legislative interest in GAC and increase the pressure on providers of these services.

Understanding how HHS’s actions, if finalized, will limit GAC services for minors requires an appreciation of how states partner with the federal government to fund Medicaid and CHIP. Several of HHS’s actions also include terminology never previously used in federal law or regulation. This client alert provides a brief overview of Medicaid/CHIP financing and the new defined terms before turning to the HHS actions themselves.