WASHINGTON — December 18, 2025 — The U.S. Department of Health and Human Services (HHS) announced Thursday a series of proposed regulatory actions aimed at prohibiting hospitals from performing sex-rejecting medical procedures on children, following an executive order issued by President Trump.
Under the proposal, the Centers for Medicare & Medicaid Services (CMS) would bar hospitals from performing such procedures on individuals under the age of 18 as a condition of participation in Medicare and Medicaid. Because nearly all U.S. hospitals rely on Medicare or Medicaid funding, the rule would effectively prevent participating hospitals from offering these interventions to minors.
The proposed regulations target pharmaceutical and surgical interventions intended to align a child’s physical characteristics with an asserted identity different from their biological sex. These include puberty blockers, cross-sex hormones, and certain surgical procedures.
“Under my leadership, and answering President Trump’s call to action, the federal government will do everything in its power to stop unsafe, irreversible practices that put our children at risk,” said HHS Secretary Robert F. Kennedy Jr. “This Administration will protect America’s most vulnerable.”
CMS Administrator Dr. Mehmet Oz said the proposal reflects the agency’s responsibility to protect patient safety. “Children deserve our protection, not experimental interventions that carry life-altering risks with no reliable evidence of benefit,” Oz said. “Hospitals participating in federal programs must meet clear standards that promote the health and safety of children.”
In addition, CMS plans to issue a separate proposed rule prohibiting federal Medicaid funding for these procedures for minors, with the same restriction applying to the Children’s Health Insurance Program (CHIP) for individuals under 19. According to HHS, 27 states currently do not cover such procedures under Medicaid.
HHS cited concerns about irreversible effects associated with the treatments, including infertility, impaired sexual function, diminished bone density, and altered brain development. Kennedy also signed a declaration concluding that these procedures do not meet professionally recognized standards of health care, based on a peer-reviewed HHS report. Under the declaration, practitioners performing such procedures on minors would be considered out of compliance with accepted medical standards.
The U.S. Food and Drug Administration also announced enforcement actions related to the issue, issuing warning letters to 12 manufacturers and retailers accused of illegally marketing breast binders to children for the treatment of gender dysphoria. FDA Commissioner Dr. Marty Makary said further enforcement actions could follow if violations continue.
HHS further announced plans to reverse a Biden-era regulatory interpretation that included gender dysphoria within the definition of a disability under Section 504 of the Rehabilitation Act of 1973. The proposed revision would clarify that gender dysphoria not resulting from a physical impairment is excluded, which officials say would allow health care providers and organizations to limit or prohibit sex-rejecting procedures without violating federal nondiscrimination laws.
Last month, HHS released a peer-reviewed report examining treatments for pediatric gender dysphoria, stating that available evidence does not support claims that puberty blockers, cross-sex hormones, or surgeries are safe and effective for children. According to federal claims data, nearly 14,000 minors received such procedures between 2019 and 2023.
The proposed rules will be subject to public comment before any final action is taken.
