MMA Opposes CMS Proposed Rule that Defunds Gender-Affirming Healthcare for Minors on Medicaid, CHIP

January 30, 2026

On January 26, the MMA submitted a formal comment in opposition to a Centers for Medicare and Medicaid Services (CMS) proposed rule that would prohibit the use of federal Medicaid and Children’s Health Insurance Program (CHIP) funds for select gender-affirming healthcare services provided to minors.  

Services subject to the rule include pharmaceutical or surgical interventions – including puberty blockers, hormone replacement therapy, and surgeries – that “attempt to align a child’s physical appearance or body with an asserted identity different from their sex.”  

The proposed rule is inconsistent with the MMA’s policy on gender-affirming healthcare. The policy, adopted in February 2023, states that the MMA “opposes laws and regulatory actions designed to restrict access to gender-affirming healthcare.” Importantly, the comment states that “consistent with the prevailing evidence-based standards of care, the MMA recognizes that…under specific clinical guidelines, it is appropriate for…minors to receive certain types of gender-affirming healthcare.”  

In its proposed rule, CMS argues that “there is a lack of reliable, long-term evidence on the safety and effectiveness of [gender-affirming healthcare] for children and…these interventions can cause irreversible, life-altering harm, including, but not limited to, permanent infertility and loss of sexual function.” 

In its comment, the MMA submits that: 

• “The weakness of evidence of benefits for [gender-affirming healthcare] does not indicate a lack of benefits, but rather that the nature of [gender-affirming healthcare] makes it difficult to employ characteristics of traditionally ‘quality’ research [e.g., small sample sizes, limited ability to isolate treatments in the context of standard-of-care step-therapy, ethical considerations of randomized control trials].”  

• “A body of research, while imperfect, collectively suggests that minors’ receipt of [this care], consistent with the [prevailing evidence-based standards of care], is associated with reduced substance use, depression, self-harm, and suicidality.” 

• “There are many effective medical treatments that include aspects of varying reversibility, and there are many effective medical treatments for which we have limited understanding of long-term side-effects. For nearly all treatments, CMS respects and yields to the patient-physician relationship and its central tenets of informed consent and shared decision-making about risks and benefits of treatments without government encroachment.”  

• “[The prevailing evidence-based standards of care] provide for the protection of minor patients in that they must ‘demonstrate the emotional and cognitive maturity to provide informed consent/assent for the treatment [and that] mental health concerns (if any) that may interfere with diagnostic clarity, capacity to consent, and gender-affirming medical treatments have been addressed’” (p.S256-S258). 

CMS has published a separate proposed rule (i.e., CMS-3841-P) that would bar hospitals from providing pharmaceutical or surgical gender-affirming healthcare services to minors as a condition of participation in Medicare and Medicaid. The MMA has opted not to comment on this second proposed rule to avoid redundancy and to defer to hospital associations.  

The MMA will continue to monitor and report on CMS rules related to minors’ access to gender-affirming healthcare. For more information, contact Adrian Uphoff, manager of health policy & regulatory affairs.