The administration of former President Donald Trump has taken its most significant step yet to restrict healthcare for transgender youth in the United States. On Thursday, 18 December 2025, officials proposed sweeping new regulations designed to effectively ban gender-affirming medical treatments for minors nationwide.
Details of the Proposed Funding Ban
The US Department of Health and Human Services (HHS), led by Secretary Robert F. Kennedy Jr., unveiled the regulatory actions. The core proposal involves cutting off federal Medicaid and Medicare funding from any hospital or medical provider that offers gender-affirming care to individuals under the age of 18. This would also apply to the State Children's Health Insurance Program (SCHIP).
Given that nearly all American hospitals participate in these federal health programmes, which cover seniors, disabled people, and low-income families, the financial threat is substantial. Losing access to these payments would imperil most US hospitals, forcing many to cease offering such treatments. Reports indicate numerous providers have already stopped in anticipation of the federal action.
Contradicting Medical Consensus and State-by-State Impact
This federal approach directly contradicts the stance of leading US medical organisations, including the American Medical Association, which advocates against restricting care for gender dysphoria. The proposed rules represent a "one-size-fits-all mandate from the federal government" on a decision that should be between a doctor and patient, according to Rodrigo Heng-Lehtinen of The Trevor Project.
Currently, Medicaid programmes in slightly less than half of US states cover gender-affirming care, while at least 27 states have laws restricting or banning it. The new federal rules would jeopardise access in nearly two dozen states where such care remains legal and funded by Medicaid. Federal judges have previously struck down state bans in Arkansas and Montana as unconstitutional, with legal battles ongoing.
Legal Challenges and Next Steps
The proposals announced on 18 December are not yet final or legally binding. The federal government must now undertake a lengthy rulemaking process, which will include periods for public comment and document rewrites, before any restrictions could become permanent.
Furthermore, the rules are highly likely to face immediate legal challenges from civil rights and healthcare advocacy groups. The process sets the stage for a protracted legal and political conflict over the rights of transgender youth and the role of the federal government in medical decisions.
Gender-affirming care for minors is a carefully managed process. It typically begins with evaluation by a team of professionals. Some youths may pursue social transition. Medical interventions can include puberty-blocking drugs to delay puberty, followed later, if appropriate, by hormone therapy like testosterone or estrogen. Surgical interventions for minors are exceptionally rare.
