Health and LGBTQ+ advocates respond to CMS proposed rules on gender-affirming care

By californialgbt | December 18, 2025

The California LGBTQ Health and Human Services Network and Health Access California respond to the draft notices of proposed rulemaking (NPRM) from the Centers for Medicare & Medicaid Services (CMS) announced today that aim to prevent access to medically necessary health care for trans youth nationally. 

“The Trump administration has made it blatantly obvious that it does not care about the health and wellness of the American people and our access to health care. Instead of lowering costs or extending critical health care subsidies, it is choosing to attack transgender and gender-diverse youth,” stated Dannie Ceseña, Director of the California LGBTQ Health and Human Services Network. “Decades of scientific, peer-reviewed research is not junk science. We continue to stand with our TGI youth and families, medical providers, and academic researchers who continue to show support in the midst of a horrific and dark time within our medical community.”

“Today’s announcement from the Trump Administration is a further escalation of their cruel, dangerous, and medically unfounded attacks on transgender youth. The proposed rules fly in the face of decades of consensus from medical professionals about the safety and life-affirming impacts of gender-affirming care – it creates a new regime where bureaucrats overrule the expertise and advice of doctors, parents, and youth themselves,” said Health Access Executive Director Amanda McAllister-Wallner. “This is not the action on health care that struggling consumers have been waiting for from the Trump administration – in fact, it undermines our health care system, pushing people away at the very time they need care the most. The Trump administration is essentially holding our hospitals hostage to force their political agenda on us all.” 

The proposed rules would: 

  1. Bar any hospital that provides best practice, medically necessary health care for trans youth (which the Trump administration defines as including puberty blockers, hormone therapy, and surgery operations) from participating in the Medicare and Medicaid programs (which nearly every hospital in the country participates in); and

  2. Prohibit Medicaid funds from covering any best practice, medically necessary health care for trans youth under the age of 18, and Children’s Health Insurance Program (CHIP) funds from covering that care for trans youth under the age of 19. 

These proposed rules do not change current law or prohibit providers from continuing to provide care. California law prohibits healthcare providers and insurers from discriminating against or denying care to transgender, gender diverse, or intersex people. Additionally, California’s shield laws such as SB 345 and SB 923 protect healthcare providers offering gender-affirming care from out-of-state legal actions, investigations, and discipline. 

The attempts this administration is making to erase and dehumanize the transgender community is deplorable. The public has 60 days to comment on these rules, and it is imperative that you do so. The more comments left, the more they will have to respond to and consider when making final decisions. The Conditions of Participation Rule and the Medicaid Funding Restriction Rule are open for public comment beginning on December 19, and we ask you to submit comments as soon as possible. 

This is not the final fight, and it demands collective action. These proposed restrictions are an intersectional attack on health equity—when one community’s care is targeted, all communities are placed at risk. LGBTQ+ and allied organizations must stand united against these harmful policies and the broader threat they pose to health, dignity, and autonomy.

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