Federal Agency Orders States to Halt Medicaid Funding for Gender-Affirming Care for Minors

Washington, D.C.

The Centers for Medicare & Medicaid Services (CMS) has instructed states to cease using Medicaid funds for gender-affirming care for minors, including gender reassignment surgeries and hormone treatments. The directive, issued under the leadership of newly confirmed CMS Administrator Dr. Mehmet Oz, has sparked significant debate over the role of federal healthcare programs in gender-affirming procedures for those under 18.

In a statement, Dr. Oz emphasized that protecting children and ensuring lawful medical practices are his top priorities. “Medicaid dollars should not be used for gender reassignment surgeries or hormone treatments for minors—procedures that may cause irreversible harm, including sterilization,” Oz said. “The medical care we support must be lawful, necessary, and in the best interest of the patient.”

On April 11, CMS communicated its decision to state Medicaid directors, outlining that all care must align with the best interests of beneficiaries, particularly vulnerable minors. The policy shift comes as CMS strives to protect children from what it considers to be potentially harmful medical interventions.

Dr. Oz’s confirmation was marked by a largely party-line Senate vote on April 3. Prior to his confirmation, the nominee faced scrutiny over past remarks supporting transgender care and abortion rights. Senator Josh Hawley, who initially opposed Oz’s nomination, reversed his stance after Oz publicly distanced himself from these positions.

Gender-affirming care has become a point of contention, especially in conservative states where lawmakers are pushing for restrictions on these procedures. A 2023 study published in JAMA Network Open highlighted that most gender-affirming surgeries are performed on young adults aged 19 to 30, with fewer than 8% of patients being minors between the ages of 12 and 18. About one-quarter of these patients were covered by Medicaid.

The issue gained national attention during the Trump administration, when President Donald Trump signed an executive order barring federal funding for gender-affirming care. The order stated that doctors were “maiming and sterilizing” children, but the move was widely criticized by medical professionals, including the American Academy of Pediatrics, which has supported gender-affirming care as a necessary option for certain patients.

Dr. Oz also noted the high costs of gender-affirming care, which can exceed $134,000, and referenced other countries reevaluating such interventions. “Like them, we believe psychotherapy, not life-altering drugs or surgery, should be the first line of treatment,” he stated. “This is about protecting individuals from decisions they may not fully understand and from irreversible consequences.”