The U.S. Department of Health and Human Services (HHS) today announced a series of proposed regulatory actions to carry out President Trump's Executive Order directing HHS to end the practice of sex-rejecting procedures on children
that expose young people to irreversible harm. These procedures include pharmaceutical or surgical interventions of specified types that attempt to align a child's physical appearance or body with an asserted identity different from their sex.
The Centers for Medicare & Medicaid Services (CMS) will release a notice of proposed rulemaking proposing to bar hospitals from performing sex-rejecting procedures on children under age 18 as a condition of participation in Medicare and Medicaid programs. Nearly all U.S. hospitals participate in Medicare and Medicaid and this action is designed to ensure that the U.S. government will not be in business with organizations that intentionally or unintentionally inflict permanent
harm on children. CMS is proposing this rulemaking pursuant to its longstanding authority in sections 1861(e)(9), 1871, and 1905(a) of the Social Security Act, which authorize the agency to establish standards necessary to protect patient health and safety in Medicare- and Medicaid-participating hospitals.
CMS will release an additional notice of proposed rulemaking to prohibit federal Medicaid funding for sex-rejecting procedures on children under age 18. The same prohibition would apply to federal Children's Health Insurance Program (CHIP) funding for these procedures on individuals under age 19. Currently, 27 states do not provide Medicaid coverage of sex-rejecting procedures on children.
Sex-rejecting procedures on children — which include puberty blockers, cross-sex hormones, and surgical operations — cause irreversible damage, including infertility, impaired sexual function, diminished bone density, altered brain development, and other irreversible physiological effects.
Health and Human Services Secretary Robert F. Kennedy, Jr. today signed a declaration, based on an HHS peer-reviewed report, finding that these procedures do not meet professionally recognized standards of health care. Under the declaration, practitioners who perform sex-rejecting procedures on minors would be deemed out of compliance with those standards.
"Under my leadership, and answering President Trump's call to action, the federal government will do everything in its power to stop unsafe, irreversible practices that put our children at risk," Secretary Kennedy said. "This Administration will protect America's most vulnerable. Our children deserve better—and we are delivering on that promise."
"Children deserve our protection, not experimental interventions performed on them, that carry life-altering risks with no reliable evidence of benefit," said CMS Administrator Dr. Mehmet Oz. "This proposal seeks to clarify that hospitals participating in our programs cannot conduct these unproven procedures on children. CMS will ensure that federal program standards reflect our responsibility to promote the health and safety of children."
The U.S. Food and Drug Administration (FDA) is issuing warning letters to 12 manufacturers and retailers for illegal marketing of breast binders to children for the purposes of treating gender dysphoria. Breast binders are Class 1 medical devices used for purposes such as assistance in recovery from cancer-related mastectomy. The warning letters will formally notify the companies of their significant regulatory violations and how they should take prompt corrective action.
"Illegal marketing of these products for children is alarming, and the FDA will take further enforcement action such as import alerts, seizures, and injunctions if it continues," said FDA Commissioner Marty Makary, M.D., M.P.H.
HHS is also moving to reverse the Biden administration's attempt to include gender dysphoria within the definition of a disability. The Office for Civil Rights' newly proposed revision to Section 504 of the Rehabilitation Act of 1973 clarifies that the definitions of "disability" and "individual with a disability" exclude "gender dysphoria" not resulting from physical impairments. The rule would reassure recipients of HHS funding that policies preventing or limiting sex-rejecting procedures do not violate Section 504's disability nondiscrimination requirements.
"The Biden administration abused a law that was never intended to require health care providers or health programs to support transgender surgeries for minors," said Health and Human Services Deputy Secretary Jim O'Neill. "Our rule would restore regulatory clarity and ensure that organizations receiving federal funds can set evidence-based policies without fear of violating federal civil rights requirements."
Last month, HHS published Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices, its peer-reviewed study of the medical dangers posed to children from attempts to change their biological sex. According to claims data, nearly 14,000 minors received sex-rejecting procedures between 2019 and 2023.
Assistant Secretary for Health and Head of the United States Public Health Service Commissioned Corps Admiral Brian Christine, M.D., today signed a public health message to inform health care providers, families, and policymakers that current evidence does not support claims that puberty blockers, cross-sex hormones, and surgeries are safe and effective treatments for pediatric gender dysphoria. "Children's health and well-being guide our every move," said ADM Christine. "Evidence shows sex-rejecting puberty blockers, cross-sex hormones, and surgeries are dangerous. Providers have an obligation to offer care grounded in evidence and to avoid interventions that expose young people to a lifetime of harm."
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