The Trump administration has increased restrictions on the use of federal funding through Medicaid and Children’s Health Insurance Program for gender-affirming care for young people. The move has sparked criticism from at least one medical association and trans advocacy groups.
Both Medicaid and CHIP aim to provide healthcare for low-income individuals, effectively serving as their health insurance. Many Republican politicians have scrutinized the use of this funding to administer gender-affirming care, such as hormone replacement therapy, and various forms of surgery.
Medicaid is a program funded by both the federal and state governments to give greater access to medical procedures for those of lower economic status, a program that many without reliable insurance depend on to cover medical costs. In states that continue to cover gender-affirming care for minors, the governments of these states will have to cover the entire cost without federal government assistance.
This came at the same time that Vice President JD Vance has called upon the U.S. Department of Justice to limit access to healthcare for transgender minors. He, along with other politicians, have claimed there is a predatory push to perform gender-affirming care on minors. According to Vance, this push he alleges is motivated by a desire from these hospitals to be able to profit off of transgender patients.
Vance also sent a letter to U.S. Attorney General Todd Blanche asking him to investigate numerous hospitals, alleging there may have been instances of fraud. In the letter, he accused these hospitals of committing fraud to get insurance to cover gender-affirming care for young people. The interventions cited by Vance include use of puberty blockers and hormone replacement therapy.
The American Academy of Pediatrics criticized Vance’s actions as interfering in legitimate healthcare for his own ideological purposes through the spreading of lies. While many other critics claim the rights of transgender youth to receive adequate care are being made the center of a culture war.
The vice president cited a report from the U.S. Department of Health and Human Services titled “Wolves in White Coats,” in which the authors accused medical practitioners of pushing young people down the path of seeking medical intervention for their gender dysphoria. In the report, many hospitals and health clinics were called out by name for allegedly participating in insurance fraud.
The World Professional Association for Transgender Health, along with other advocates for LGBTQ+ rights, were accused in the report of encouraging hospitals to use fraudulent methods to get state-sponsored insurance programs to cover procedures.
The report accused healthcare workers and clinics of funneling young patients down a “pathway of chronic care,” in which they would need decades of medical intervention. It also claimed that so-called “sex rejecting procedures” became “a reliable revenue line that helps subsidize lower-margin services” for hospitals throughout the country.
On Page 14 of the report, medical professionals were alleged to have coded patients as having an endocrine disorder in official documents instead of using the code for gender dysphoria or “transsexualism.” The authors also accused medical professionals of falsely recording cases of precocious puberty in order for puberty blockers to be covered by Medicaid for youth with gender dysphoria. This report accused WPATH of having encouraged medical professionals to lie to obtain coverage for different procedures they might perform.
The report also painted a picture of parents desperately wanting to help their mentally troubled children being deceived by doctors attempting to groom these children with “gender ideology.” This portrayal, critics argued, sought to paint medical practitioners as untrustworthy and motivated by their political biases instead of by their desire to care for their patients.
President Donald Trump has also recently issued an executive order preventing Medicaid and CHIP funds from being used on gender-affirming care. According to critics, the current administration has used its power over these two organizations to punish transgender youth.
Trump’s new rule requires that state Medicaid programs stop paying for what his administration refers to as “sex-rejecting procedures,” as opposed to the more commonly used term “gender-affirming care,” for minors.
Kelley Robinson, president of the Human Rights Campaign, said the Trump administration has done little to combat the problem of healthcare being largely unaffordable throughout the country, while being hyperfocused on transgender medicine. Instead of taking steps to better the country’s healthcare system, low-income individuals are having their access to medically necessary treatment offered by qualified professionals restricted, according to Robinson.
Before Trump’s executive order in early August, states had the authority to determine how Medicaid funding was being used. Now that the order has gone into place, these states will be forced to foot the bill for gender-affirming care without the federal government’s financial assistance because the Trump administration does not approve of what it calls “transgender ideology,” critics have said.
Additionally, numerous states have already begun to legally challenge the new restrictions. Connecticut Attorney General William Tong led a coalition of 22 states, including New Jersey and New York, against the recent changes to Medicaid and CHIP federal fund usage for transgender youth.
New York Attorney General Letitia James released a statement in early September condemning the federal government’s actions and accusing it of overstepping its authority in attempting “to dictate what medically necessary care New York provides to its residents.” James, along with other coalition members, also said in the statement that Congress never gave the Centers for Medicare & Medicaid Services the authority to refuse to pay for treatment that has been based on evidence.
In a letter addressed to HHS Secretary Robert F. Kennedy Jr. in February, the dissenting states accused the Trump administration of having “repeatedly and aggressively targeted transgender individuals, curtailed transgender youth healthcare, instilled fear in healthcare providers and patients, and attempted to usurp state oversight of medical care.”
Rather than an attempt to keep young people safe from harm, these states said the new rule surrounding Medicaid discredits the authority of qualified medical practitioners. They said they fear that healthcare workers will be inhibited by increased public scrutiny and lack of funding because of the recent changes.
Opponents of the policy changes regarding Medicaid and CHIP funding argued that this specifically targets those of lower economic means, making it one of the many instances in which the Trump administration has attacked programs that aim to alleviate poverty. The administration, opponents said, has now targeted SNAP as a part of the president’s “One Big Beautiful Bill.”
According to U.S. News and World Report, around 5 million Americans already have lost eligibility for SNAP benefits under Trump. The most drastic change is that now states have to pay three-quarters of the funding for SNAP, when in the past the federal government took on half the burden of funding the program that helps people dealing with food insecurity.
Much like the changes to funding programs like Medicaid and CHIP, the changes to SNAP punish states that wish to support those who are economically disadvantaged, according to critics. Ultimately, critics said, they believe the changes appear to target working class Americans for the current administration’s own ideological purposes.
