The Trump administration is preparing to introduce sweeping new restrictions on gender-affirming healthcare for transgender young people across the United States, according to leaked documents obtained by NPR.
The proposals — reportedly from the Department of Health and Human Services (HHS) — would prohibit federal Medicaid reimbursements for gender-affirming treatments provided to trans patients under 18, while also blocking all Medicaid and Medicare funding for hospitals that offer such care to minors.
A source within the Centres for Medicare and Medicaid Services (CMS), speaking anonymously to NPR, said the draft rules are expected to be released in early November.
A “Significant Escalation” in Anti-Trans Policy
Health policy expert Katie Keith, director of the Centre for Health Policy and the Law at Georgetown University, described the proposed regulations as a “significant escalation” in the Trump administration’s ongoing campaign against transgender healthcare.
“It’s really, really important to note that nothing is changing immediately,” Keith told NPR.
“These would be proposals that would go out for public comment. It would take months for the administration to issue a final rule — and, if past is prologue, we would see litigation over whatever the final rules are.”
Support from Conservative Groups
Meanwhile, conservative organisations have welcomed the proposals.
Terry Schilling, president of the American Principles Project, told NPR that his group supports the move because it would eliminate public funding for gender-affirming treatments.
“They believe that if you want to get some type of sex-trait modification procedure, you should have to pay for it,” Schilling said. “The American people are fully behind this effort.”
Legal Experts Raise Alarm
Katie Eyer, a law professor at Rutgers University and parent of a transgender child, warned that the proposed rules could be devastating if implemented.
“I shudder to think what this administration would do with such a tool in their hands,” she said, noting that the measures would likely face legal challenges.
Eyer added that the administration’s focus on anti-trans policies has been “an obsessive campaign”, leaving real families in distress.
“There are real people behind all this,” she said. “People are really scared and suffering as a result of this onslaught of attacks on the trans community.”
Part of a Broader Crackdown on LGBTQ+ Rights
Since returning to office in January, Donald Trump has signed several executive orders targeting transgender Americans.
These include:
- Declaring that the official policy of the U.S. is that there are “only two sexes”
- Reinstating the ban on transgender people serving in the military
- Prohibiting trans women from competing in women’s sports
- Restricting gender-affirming healthcare for people under 19
- Dismantling diversity, equity, and inclusion (DEI) programs across federal agencies and the armed forces
Currently, 27 U.S. states have enacted state-level bans on gender-affirming care for minors. Data from the Human Rights Campaign (HRC) shows that approximately 40% of transgender youth aged 13–17 — about 120,400 young people — now live in states where such care is outlawed.
A Legislative Pattern of Restriction
The leaked proposal follows a string of legislative efforts limiting access to healthcare for trans Americans.
In May 2025, the U.S. House of Representatives narrowly passed the One Big Beautiful Bill Act (215–214), which slashed funding for several federal programs and eliminated coverage for gender-affirming care under both Medicaid and Obamacare.
Earlier, in December 2024, Congress passed the National Defence Authorisation Act (NDAA) for Fiscal Year 2025, which included a clause banning the military health program, Tricare, from funding gender-affirming procedures for minors.
If enacted, the leaked HHS rule would extend these restrictions nationwide — a move that legal experts say could dismantle access to essential, evidence-based healthcare for thousands of transgender adolescents across the United States.
