New warning about CMS rule to ban funding of gender-affirming care

WASHINGTON — The Trump administration is implementing a new strategy to restrict Medicaid coverage for drugs used in gender-affirming care. This approach might also serve as a basis for denying coverage for other medications, challenging the common belief that Medicaid covers most prescription drugs.

The Centers for Medicare and Medicaid Services recently finalized a rule that prohibits using federal Medicaid and CHIP funds for pediatric gender-affirming medications and surgeries. Set to be enforced on Oct. 13, this rule is the latest step in the administration’s efforts to limit transgender health care for minors.

Experts in the Medicaid field suggest that this rule could create a broader precedent for refusing coverage of drugs and services beyond those related to gender-affirming care. Typically, Medicaid is required to cover most outpatient drugs approved by the Food and Drug Administration for recognized medical uses, provided that drug manufacturers agree to offer substantial rebates to be included in the Medicaid program.