With the threat of federal funding being pulled next month, at least five other states nationwide plan to join Massachusetts in covering minors’ transgender health care through Medicaid.
Their decisions come after a new rule from the Trump administration that will cut off federal funding for many treatments.
The Centers for Medicare and Medicaid Services finalized a rule in August blocking the use of Medicaid money for transgender care for anyone younger than 18. The rule is set to take effect in October.
Massachusetts and 21 other states sued the Trump administration over the rule this week. They’re asking a Boston federal judge to declare it unlawful and stop it from taking effect, arguing it breaks with precedent that allows states to decide what their public health insurance covers.
“The Trump Administration’s latest attack on access to gender-affirming care for young people unlawfully undermines states’ authority to regulate healthcare and tries to strip healthcare access from vulnerable kids,” Massachusetts Attorney General Andrea Campbell said in a press release announcing the lawsuit.
Massachusetts officials have confirmed that the commonwealth will use funds set aside by the state legislature to pay for that care.
“What I want folks to know and be aware of is that here in Massachusetts, gender-affirming care — for children, for adolescents, for adults — remains legal, it remains available, and it remains covered by our state Medicaid program and by our commercial insurers based here in the state,” Dr. Robbie Goldstein, Massachusetts’ commissioner for public health, told GBH’s Morning Edition last month.
“We at the Department of Public Health manage the Affirming Health Care Trust Fund,” he continued. “We’re going to use those dollars as we need to, to support care for youth and adolescents on our state Medicaid program, MassHealth.”
More than half of states already refuse to cover minors’ gender-affirming care with public health insurance, according to research from the LGBTQ+ advocacy group Movement Advancement Project.
Several other states’ Medicaid administrators told GBH News they are still figuring out their next steps.
But Massachusetts, Maine, Vermont, California, New Mexico and Maryland all confirmed they will continue to cover minors’ gender-affirming medications on Medicaid.
“We remain committed to making sure all Vermonters have access to the care they need,” said Alex McCracken, a spokesperson for the Department of Vermont Health Access.
She added that access to gender-affirming care is protected under state law, so Vermont must and will use state funds to backfill any federal losses. Fewer than 200 minors currently get their gender-affirming care covered by the Vermont plan, McCracken said.
Neither Rhode Island nor Connecticut confirmed if they would continue to cover the care.
“The Connecticut Department of Social Services believes in meeting the health care needs of all our clients, including our young people,” said Christine Stuart, a spokesperson from the state’s Department of Social Services. “While ongoing litigation limits what we can address publicly right now, our commitment to supporting the full spectrum of our clients’ needs remains unchanged.”
New Hampshire broadly bans gender-affirming medications for minors.
The Trump administration has consistently argued that transgender health 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.
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. Counseling will still be covered under the federal changes.
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.
Material from prior GBH News articles was used in this story.
