The U.S. Department of Health and Human Services, through the Centers for Medicare & Medicaid Services, issued a final rule ending the use of federal Medicaid and CHIP funds to pay for sex-rejecting procedures on children and youth.
“Today, we are ending federal taxpayer funding for sex-rejecting procedures on children,” Secretary of Health and Human Services Robert F. Kennedy, Jr. said. “These interventions carry serious risks and can cause irreversible harm. The federal government will no longer use Medicaid and CHIP dollars to fund procedures that fail to meet the evidentiary standard our children deserve.”
“Children deserve our protection, not experimental interventions that pose serious risks and convey no proven benefits,” said CMS Administrator Dr. Mehmet Oz.
HHS states that sex-rejecting procedures on children, which include puberty blockers, cross-sex hormones, and surgical operations, can result in irreversible damage, including infertility, impaired sexual function, diminished bone density, altered brain development, and other lasting physiological effects.
CMS’s decision follows a review of national and international research by HHS that identified significant evidence gaps, documented serious safety concerns, and concluded that the evidence supporting these interventions for children remains insufficient to justify federal taxpayer funding. CMS also points to international reviews, including the United Kingdom’s Cass Report.
Under CMS-2451-F, a State Medicaid plan must provide that the Medicaid agency will not make payment for sex-rejecting procedures for children under 18, and a separate CHIP plan must provide that the CHIP agency will not make payment for those procedures for children under 19.
Federal Medicaid and CHIP funding will be available for a tapering-off period of up to six months from the effective date for children currently on hormone therapy. The rule does not affect coverage of mental health services. HHS states this action applies only to federal Medicaid and CHIP funding.
The final rule is scheduled to take effect October 13, 2026.
This is a funding rule for two federal programs. It is separate from HHS’s November 2025 evidence review, *Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices*.