The Trump administration’s Centers for Medicaid & Medicare Services on Monday, Aug. 10, published a final rule that will “severely restrict access to transition-related care for transgender youth,” according to a statement by Advocates For Trans Equality Health Policy Analyst SMK. The A4TE statement went on to call the new rule “an openly discriminatory attack without any credible medical or financial basis” that “marks a serious escalation in this administration’s ongoing efforts to dismantle health care access for trans youth, endangering the lives of many of the youth who depend on this care.”
Under this new rule, federal Medicaid and CHIP reimbursement will no longer cover puberty-suppressing drugs, cross-sex hormone therapy or gender-transition surgeries for minors.
It is important to note that despite right-wing politicians’ insistence on focusing on gender-transition surgery for minors, according to the Harvard T.H. Chan School of Public Health, citing studies published in medical journals like JAMA Network Open that show zero gender-affirming surgeries are performed on any child age 12 or younger, and that for adolescents ages 15 to 17, the rate is roughly 2.1 per 100,000 teens. Additionally, nearly all such procedures are chest related — or “top surgery” rather than genital surgeries.
The new rule is set to take effect Oct. 13 this year. Current minor beneficiaries actively receiving gender-affirming hormone therapy will have a six-month “transition window,” although that “grace period” excludes puberty blockers, A4TE notes. Mental health services and counseling for gender dysphoria will still be covered under Medicaid and CHIP and the rule does not restrict private insurance coverage or care provided to cisgender youth.
During the public comment period preceding the new rule, A4TE and its coalition partners “organized a campaign to submit nearly 35,000 comments to oppose the rule.”
The A4TE statement continues, “Medical decisions should be made between patients and their doctors; the federal government has no place in these critical and personal decisions. Transition-related health care is essential and medically necessary health care that has been widely accepted by leading medical organizations for decades. This rule targets the provision of safe health care for trans people, while making the same treatments available to cisgender youth. Such a double standard is plainly discriminatory.”
A4TE warns of “grave consequences” resulting from the administration’s “ongoing attacks on transition-related health care for youth,” adding that “Families already facing clinic closures and delayed care now must deal with the real possibility that this care could be completely inaccessible. We already know the devastating impact that restricted access to reproductive health care has had, especially in rural areas.
“Trump has already made deep cuts to Medicaid that stripped health care from millions of people in this country and has continued to pour critical resources into vilifying and attacking the health care rights of trans people,” the statement continues. “This rule is the latest move by the administration to hollow out the health care safety net for those who need it the most. Trans youth and their families are the target of this rule, but they are using this same tactic to target other vulnerable communities.
“CMS finalized this rule fully aware that the consequences could be deadly — as that is the precise goal of these policies, in the administration’s own words. The question we all must ask is, ‘Who benefits from medical care being slashed, and who has the pay the price?’
“Good, evidence-based public health policy must focus on expanding access to medical care, fostering innovation, and reducing costs for all patients, not issuing discriminatory regulations that restrict access at a time where people across the country struggle with rising health care costs.”
— Tammye Nash