A new rule from the Trump administration this week means the federal government will stop covering gender-affirming treatments for transgender children who rely on public health insurance like Medicaid.
But in what appears to be a first-in-the-nation policy, Massachusetts officials with MassHealth say the state will keep covering the costs of treatments like hormone therapy.
The Centers for Medicare and Medicaid Services finalized a rule Tuesday blocking the use of Medicaid money for transgender care for anyone younger than 18. The rule is set to take effect this fall.
If and when the rule takes effect, state officials confirmed they’ll use funding out of the state’s $8.5 million Affirming Health Care Trust to cover the potential gap in health care coverage.
“President Trump continues to attack the health and wellbeing of all people,” Gov. Maura Healey told GBH News in an emailed statement. “Here in Massachusetts, we are going to keep working with providers to make sure that everyone — including LGBTQ residents — can get the essential health care they need.”
The Trump administration has consistently argued that gender-affirming care for minors is experimental and lacks clear benefits. Dr. Mehmet Oz, who leads the federal Centers for Medicare & Medicaid Services, said in a statement that this change will save taxpayer dollars and protect children from harm.
The federal rule also bars the Children’s Health Insurance Program from covering gender-affirming care for anyone younger than 19. It was first proposed last year and takes effect on Oct. 13. Anyone already receiving such treatment would continue getting the federal funding support for six more months.
Twenty-six states already refuse to cover minors’ gender-affirming care with public health insurance, according to research from the LGBTQ+ advocacy group Movement Advancement Project.
Medical treatment for what’s diagnosed as gender dysphoria can vary. For many minors, health care providers will offer counseling and sometimes medications known as puberty blockers or hormone replacement therapy.
But surgical intervention is exceedingly rare: In Massachusetts, no bottom surgeries for gender dysphoria — vaginoplasties or phalloplasties — were performed on anyone ages 18 or younger under MassHealth in 2024, medical billing data show.
Experts estimate there are about 14,000 transgender teens in the state. Not all of them want to take puberty blockers or undergo hormone replacement therapy. But limiting access to that kind of care is linked to more suicide attempts among trans youth.
Over the past two years, the Trump administration has released a litany of declarations, regulations and investigations into medical providers to curtail transgender health care for minors. It’s led some medical centers in Massachusetts — including Baystate Health, Fenway Health and Outer Cape Health Services — to stop offering puberty blockers and hormone therapy to trans kids.
Massachusetts Attorney General Andrea Joy Campbell called the Trump administration’s latest rule “yet another attempt” to scare and intimidate health care providers and patients.
“Transgender young people deserve to live with dignity, respect, and the freedom to access lifesaving healthcare that supports their emotional and physical wellbeing,” Campbell said in a statement. “The fact remains that federal law does not prohibit gender-affirming care for minors, and Massachusetts law continues to protect this care.”
MassHealth could not immediately provide estimates of the potential cost to the state. Last year’s medical billing data shows about 550 MassHealth recipients, ages 18 and younger, were receiving hormone treatments or puberty blockers for gender-affirming purposes.
LGBTQ+ advocates with MassEquality are outraged by the Trump administration’s move this week.
“This is bigotry masquerading as healthcare policy,” Tanya Neslusan, MassEquality’s executive director, said in a statement. “This is not about protecting children. It is about targeting transgender people and putting politicians between patients, parents, and their doctors.”
A more sweeping federal proposal aimed at limiting gender-affirming care for minors appears to be shelved. That rule, if finalized, would have made it harder for medical centers to provide gender-affirming care to trans youth. The rule would have essentially given health care facilities an ultimatum: Stop providing the care, or lose federal funding.
NPR reported earlier this summer that officials were backing off that proposal.
Material from prior GBH News stories was used in this story.
