A new Trump administration rule ending federal Medicaid and Children’s Health Insurance Program (CHIP) funding for certain gender-affirming care for transgender minors is expected to reshape access to treatment for low-income families, while legal challenges and state responses could determine how broadly the policy is implemented.

The rule, finalized Tuesday and scheduled to take effect October 13, would prevent states from receiving federal Medicaid and CHIP reimbursement for gender-affirming medical services for minors. The policy covers treatments such as puberty blockers, hormone therapy and, in some circumstances, surgical procedures. Gender-affirming care can also involve medical monitoring and supportive care for young people and their families. Surgeries are uncommon among minors. The administration says the change is intended to protect children from medical interventions it considers insufficiently supported by evidence. Department of Health and Human Services spokesperson Emily Hilliard said federal health care dollars should support care that protects children and has reliable evidence of safety and clinical benefit.

Medical organizations, researchers and LGBTQ+ health advocates have challenged the administration’s characterization of gender-affirming care and warned that limiting coverage could create additional barriers for young people who already have difficulty accessing health care. The final rule received nearly 35,000 public comments, with about 90% opposing the proposed policy, according to the National Women’s Law Center.

Ma’ayan Anafi, senior counsel for health equity and justice at the National Women’s Law Center, called the rule “incredibly dangerous,” arguing that it is not consistent with the available evidence on gender-affirming care.

The policy is also arriving as the evidence and medical debate surrounding care for transgender youth continue to evolve. A 2026 study published in JAMA Pediatrics using Medicaid and CHIP data examined gender-related care among young people between 2019 and 2023. Researchers estimated that about 3.3% of U.S. adolescents ages 13 to 17 identify as transgender or gender diverse. The national policy fight is significant because Medicaid and CHIP serve a large share of children in families with limited incomes. Medicaid and CHIP together cover approximately 78 million people, according to the Centers for Medicare & Medicaid Services. For families who depend on public insurance, losing federal reimbursement can mean that a state must decide whether to assume the cost or that families must find another way to pay for treatment.

That financial question is central to the health access implications of the rule. Young people enrolled in Medicaid are more likely to experience economic barriers to care, and the Guardian reported that Medicaid and CHIP beneficiaries are also more likely to be people of color or have disabilities.

For transgender youth of color, those challenges can overlap with existing experiences of discrimination and unequal treatment in the health care system. Research examining health care experiences among transgender and gender-diverse youth has found that barriers can differ across racial and ethnic groups, with particularly pronounced challenges reported among Black and Hispanic transgender women. More recent research has also highlighted barriers affecting Indigenous, Black and Latine transgender and nonbinary young people. Researchers found that Indigenous participants were more likely to report difficulty finding clinics and obtaining parental support, while Black participants more frequently reported not knowing that gender-affirming care was available and negative health care experiences related to race or ethnicity. Latine participants reported concerns about cost and negative experiences related to race or ethnicity among the barriers affecting access.

Those disparities matter as states respond differently to the federal policy. A Williams Institute analysis released earlier this year estimated that approximately 724,000 U.S. teenagers ages 13 to 17 identify as transgender. About 53%—roughly 382,800 young people—live in states with at least one law or policy restricting transgender youth, including restrictions affecting gender-affirming care. The analysis found that 17 states had policies prohibiting Medicaid funding for gender-affirming care for minors even before the new federal rule.

The policy landscape therefore varies substantially depending on where a family lives. Massachusetts officials, for example, have said the state will cover hormone therapy and counseling for transgender children and teenagers enrolled in its public insurance programs if the federal policy takes effect. Other states may make different decisions, potentially creating larger geographic differences in access. The new rule does not necessarily mean that every transgender minor will immediately lose access to treatment. The Guardian reported that states could use their own Medicaid funds to continue covering services without federal reimbursement, while legal challenges could delay or block the federal policy altogether. The rule also provides a transition period for young people receiving certain medications.

For families, clinicians and caregivers, the changing rules make it increasingly important to distinguish between political claims and individualized medical advice. Gender-affirming care is not a single treatment; it can involve different forms of medical, mental health and supportive care depending on a patient’s age, health needs and circumstances. Research has also consistently identified health care access and discrimination as important factors affecting transgender and gender-diverse young people.

The federal rule is likely to remain contested as lawsuits move through the courts and states determine whether they will continue covering care with state resources. But regardless of the outcome of those legal battles, the policy has already raised a broader health equity question: when public insurance coverage changes for a politically contested form of care, who is most able to absorb the resulting costs? For transgender youth from low-income families and communities already facing racial, geographic or disability-related barriers to health care, the answer could determine whether medically recommended care remains accessible or becomes increasingly out of reach.