On 19 December 2025 the Federal Register published CMS-2451-P, a proposed rule. It is not the later August 2026 final rule (CMS-2451-F), and a proposal is not an enacted funding cutoff.
What the proposal would do. A State Medicaid plan would have to provide that the Medicaid agency will not pay for sex-rejecting procedures for children under 18, and would prohibit using federal Medicaid dollars for those procedures under 18. A separate CHIP plan would have to provide the same for children under 19 and prohibit federal CHIP dollars for those procedures under 19.
Comments were due by 5 p.m. on 17 February 2026. This document does not, by itself, change what states may pay or what clinicians may do. The final funding rule came later (11 August 2026) and is scheduled to take effect 13 October 2026 — see that separate post.
Official source
- Federal Register, 19 December 2025, 90 Fed. Reg. 59441, FR Doc. 2025-23464: govinfo.gov