Fact Check: Has the US Banned Medicaid from Paying for Transgender Surgeries for Minors?
The claim that “the US banned Medicaid from paying for transgender surgeries for minors” circulates frequently in online discussions and media headlines. However, as of February 2026, this statement is not accurate — there is no active, nationwide federal ban in place. Instead, the Trump administration has proposed significant restrictions through regulatory actions, but these remain in the proposal stage and are not yet enforceable law.
What Actually Happened: Proposed Rules from December 2025
In December 2025, the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) announced two key proposed rules stemming from President Trump’s January 2025 Executive Order 14187, titled “Protecting Children from Chemical and Surgical Mutilation.” This executive order directed federal agencies to limit or end federal support for what it describes as “sex-rejecting procedures” on children, including puberty blockers, cross-sex hormones, and gender-affirming surgeries.
The two proposed rules are:
Medicaid and CHIP Funding Prohibition (CMS-2451-P): This would prohibit federal Medicaid dollars from covering “sex-rejecting procedures” for individuals under 18, and Children’s Health Insurance Program (CHIP) funding for those under 19. Procedures include puberty blockers, hormone therapy, and surgeries intended to align physical appearance with a gender identity different from biological sex. Limited exceptions exist for treating intersex conditions or complications from prior procedures. Hospital Conditions of Participation (CMS-3481-P): This would bar Medicare- and Medicaid-certified hospitals from performing these procedures on minors as a requirement for program participation. Since most U.S.
hospitals rely heavily on Medicare and Medicaid reimbursements (accounting for nearly half of hospital revenue), this could effectively prevent many facilities from offering such care to minors, regardless of the patient’s insurance.
These proposals were published in the Federal Register on December 19, 2025, with a public comment period ending February 17, 2026. As of late February 2026, the rules are still under review — they have not been finalized, and no implementation date has taken effect. Public comments, including strong opposition from medical organizations, state attorneys general, and advocacy groups, continue to highlight concerns over statutory authority, potential violations of Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) requirements, and impacts on transgender youth health.
Related Legislative Efforts: H.R. 498 and Others
A companion bill, H.R. 498 (Do No Harm in Medicaid Act), introduced in January 2025, seeks to prohibit federal Medicaid funding for gender transition procedures on minors. Sponsored by Rep. Dan Crenshaw (R-TX), it passed the House on December 18, 2025, but has not advanced in the Senate or become law. Without Senate approval and presidential signature (already likely given administration support), it remains pending legislation, not enacted policy.
Other House-passed bills, like those criminalizing certain care, have stalled similarly. No comprehensive federal statute currently bans Medicaid coverage nationwide.
Pre-Existing Landscape: State-Level Variations and Broader Restrictions
Before these federal proposals, Medicaid coverage for gender-affirming care varied by state. Approximately half of states explicitly covered it under federal non-discrimination rules (e.g., Section 1557 of the Affordable Care Act), while others restricted or excluded it. By 2026, 27 states have enacted laws or policies limiting youth access to gender-affirming care, including surgeries (which are rare for minors anyway, per guidelines from organizations like WPATH). The U.S. Supreme Court’s June 2025 ruling in United States v.
Skrmetti upheld Tennessee’s state ban against equal protection challenges, allowing many restrictions to stand, though some face ongoing court blocks (e.g., in Arkansas and Montana).
Even without a federal Medicaid ban, state laws already limit access in many areas. The proposed federal rules aim to extend restrictions nationwide via funding mechanisms, potentially affecting low-income transgender youth disproportionately, as Medicaid covers a significant portion of children in need.
Medical and Policy Context
Major medical bodies, including the American Medical Association, American Academy of Pediatrics, and others, view gender-affirming care as evidence-based for some transgender youth, potentially reducing risks like depression and suicidality. Critics cite limited long-term data, potential irreversibility, and risks such as infertility or bone health issues.
The proposals reflect ongoing debates, with the administration emphasizing caution and protection from “irreversible harm.” Opponents argue they exceed agency authority, ignore medical consensus, and could harm vulnerable youth.
Conclusion: Proposed, Not Banned
No, the US has not banned Medicaid from paying for transgender surgeries (or broader gender-affirming care) for minors. The relevant policies are proposed rules under review, not final or in force. Claims of a full ban overstate the current reality — enforcement awaits finalization, potential legal challenges, and possible court injunctions (as seen with earlier executive order blocks in some states).
The situation remains dynamic, with significant political, legal, and medical implications. Transgender youth and families should consult state-specific resources and providers for the latest access details, as federal changes could reshape availability if finalized. a a
