Legal Voice joined partners in Montana and Washington to submit two public comments that oppose rules proposed by the Trump administration to ban gender-affirming care.
These rules are not final yet. But if adopted, they would make it difficult — or impossible — for youth to access essential, evidence-based care.
What these rules would do
The Centers for Medicare & Medicaid Services (CMS) have proposed two related rules:
1. Medicaid and CHIP Ban: This rule would ban Medicaid and CHIP (Children’s Health Insurance Program) from covering gender-affirming care for young people. These programs provide coverage for 36 million low-income youth, or around half of all youth in the country.
2. Hospital Ban: This rule would prohibit hospitals that accept Medicaid or Medicare funds from providing gender-affirming care to youth. Virtually every hospital in the country accepts Medicaid and Medicare funds.
Why access to gender-affirming care is essential
Every major medical association in the United States supports gender-affirming care. Studies have repeatedly shown that when transgender youth receive this care, suicide rates decrease and youth experience improvements in their overall well-being.
In its rulemaking, however, CMS ignored this overwhelming body of evidence. It instead relied upon flawed and biased analyses of gender-affirming care from the United Kingdom and the U.S. Department of Health and Human Services. To make matters worse, CMS also misinterpreted the review from the UK, which does not in fact recommend banning gender-affirming care.
How these rules would affect youth, families, & health care providers
Blocking Medicaid and CHIP from covering gender-affirming care would mean that many families would simply not be able to afford it. Paying out of pocket is prohibitively expensive and can cost up to $26,000 every three months.
Blocking hospitals from providing gender-affirming care will drastically reduce the number of providers and facilities providing gender-affirming care, cutting off services for many. It would also force many families to travel long distances to access other providers, resulting in high costs for airfare, gas, hotels, and lost wages. Some would need to permanently relocate, forcing them to uproot their entire lives.
Together, these two rules promote a culture of prejudice that endangers both transgender people and gender-affirming care providers.
Transgender youth are more likely to commit suicide than their peers because of the stigma and mistreatment that they encounter. According to a 2024 report from the Trevor Project, 49% of transgender and nonbinary youth in Montana and 42% of those in Washington have seriously considered suicide.
Because of anti-transgender policies and rhetoric, gender-affirming care providers regularly encounter protestors at their clinics and receive death threats. These experiences have prompted clinics to hire security guards, install panic buttons and cameras, and remove all information about their staff from the public domain.
“I am scared, not just for myself, but for my family,” wrote one Seattle physician after Trump issued an executive order targeting care for transgender youth. “It is a terrifying time to be a doctor providing gender-affirming care.”
What happens next
CMS is required to review all relevant, timely public comments before issuing a final rule. There is no set timeline for this process.
Legal Voice will continue advocating for transgender youth, their families, and everyone who supports them. All young people deserve to live as their authentic selves — and access the health care that’s right for them.
Read the comments we submitted in response to CMS’s proposed rules:
