The Trump administration’s campaign to limit and defund gender-affirming health care for young people met another roadblock on Aug. 14 when Massachusetts Attorney General Andrea Joy Campbell won a multistate lawsuit against the Trump administration over gender-affirming care coverage under the Affordable Care Act.

This victory came as several local clinics have shut down their programs despite the fact that federal funding cut threats have not come to fruition. For more on that, and to discuss the Trump administration’s latest moves on vaccines, GBH’s Morning Edition host Tori Bedford spoke with Robbie Goldstein, commissioner of the Massachusetts Department of Public Health. What follows is a lightly edited transcript.

Tori Bedford: So you’ve done a lot of work to protect gender-affirming care, including founding the Transgender Health Program at MGH. What do you make of this most recent development within the larger landscape of attacks on trans healthcare?

Support for GBH is provided by:
Become a GBH sponsor

Robbie Goldstein: What I want folks to know and be aware of is that here in Massachusetts, gender-affirming care for children, for adolescents, and 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. This action by the Attorney General and the coalition of attorneys general from Mother states is great to see. It reiterates that this care is necessary, that this care is affirming for people, and in many cases, this care is life-saving, and therefore it should be protected here in the state of Massachusetts.

Bedford: Within the context of those federal funding pressures, Fenway Health, Baystate Health, and Outer Cape Health Services have all halted or limited gender-affirming care for patients aged 18 and under. We’ve heard from local families of trans and gender-diverse young people who are really frustrated by these changes. They’ve been calling for the state to get involved. Is there a way to do that? Could the state incentivize this type of care in some way for these clinics?

Goldstein: I think the state is really involved in this type of care. I will point to the legislature, which took the lead by creating an affirming healthcare trust fund and funding that over the past year so that we have the money available to support care for youth and adolescents here in Massachusetts. We have the governor coming out and showing her support for gender-affirming care and for trans and non-binary folks. And clearly, as we just discussed, we have the Attorney General standing up in court to protect this type of care.

I’m in conversation with providers all across the state, and I think we have to remember that each provider, each organization is unique and different. Right now, there are many providers in the state that are standing with their gender non-conforming and their transgender youth and adolescent patients, providing care, prescribing the medications, And we as the state are leaning in, we’re trying to make sure that that remains affordable, that we can pay for that care when necessary, and that we can provide the protections that folks need, the providers, the families, the individuals who are receiving the care.

Bedford: Access to gender-affirming care for trans and gender-diverse youth remains under attack by the federal government. And there are some independent organizations like Transhealth that are trying to address those gaps. Others in the works like Project Beacon. How’s the state supporting those efforts?

Goldstein: I think first and foremost, we’re providing money, which is really helpful for those organizations. There was a rule that came out of the Centers for Medicaid and Medicare Services this past week that makes it such that the state Medicaid program can no longer get federal dollars to support this type of care. We at the Department of Public Health manage the Affirming Health Care Trust Fund. We’re going to use those dollars as we need to, to support care for youth and adolescents on our state Medicaid program, MassHealth. I think that’s going to be very helpful to folks like Transhealth and other organizations that come up. But we’re also doing what we need to do to protect the providers at those organizations. These are smaller organizations, they’re not backed by large hospital systems or healthcare systems. The Department of Public Health has implemented much of the SHIELD law protections that were passed, both the first version and the second version. We’ve put those protections through our health professional licensure boards so that the nurses, the physicians, the physician assistants that are working in those programs feel protected and supported by the state, by the Department of Public Health.

Support for GBH is provided by:
Become a GBH sponsor

Bedford: School is just about to start. President Trump signed another executive order earlier this month overhauling childhood vaccine recommendations. What is that all about? It really slimmed down the list, right?

Goldstein: Well, what is that executive order all about? I’d like to maybe quote the governor if I can when she came out and said it was “crazy nonsense.” I think if you actually read the executive order, it doesn’t really do much. It doesn’t change our recommendations here in Massachusetts. It doesn’t change what vaccines are paid for by our state vaccine program or by health insurers here in Massachusetts. It doesn’t change our insistence here in Massachusetts that we’re going to use science and evidence to drive our recommendations. What it does do is that it shakes families’ trust and confidence in the vaccine process, and so I really am encouraging folks across Massachusetts to look to the Massachusetts Department of Public Health for our recommendations, which are evidence-based. Look to your pediatrician or your family medicine provider so that individual can talk with you about vaccines, the safety of vaccines, and the effectiveness of the vaccines that are on our recommended schedule.

Bedford: Right. So if you’re a parent or guardian and you have questions, just talk to your doctor. You can space things out. You can do things at your own pace. In terms of questions about the actual vaccines, I was curious why they left certain things on and took others off the list of recommendations. I saw that hepatitis A and B were removed. I think meningitis as well.

Goldstein: I don’t want to suppose that I understand what’s inside the brain of Secretary Robert F. Kennedy Jr. and folks in the Trump administration, but they have over the past year and a half continued to push for fewer vaccines and to shake confidence in the vaccines that we’re giving. That doesn’t take away the fact that we have decades of experience with many of these vaccines, and we know that these vaccines, hepatitis B in particular, are incredibly safe and very effective. After the implementation of the hepatitis B recommendation, the universal recommendation for every child born in this country, we saw a dramatic drop in infant hepatitis B infection. It is really remarkable to look at the data, to look at those numbers. And now, after nearly 30 years of using that vaccine, we know that it’s safe, and we know that children who receive it have no long-term complications from the vaccine. That means that we should continue to give it, not that we should walk away from our commitment to that.