Access to gender affirming care for minors: CMS Proposals and Public Comment Periods

On December 18th, 2025 the Centers for Medicare and Medicaid Services introduced two proposals to the conditions of participation for Medicare and Medicaid reimbursement.  These proposals would severely restrict access to gender-affirming care for minors. Additionally, the second proposal, which would bar hospitals and their affiliated clinics from reimbursement eligibility if gender affirming-care is provided to minors, is an unprecedented use of these conditions. This funding restriction closely mimics the strategy long in use by our federal government to restrict abortion care internationally by the ‘Mexico City Rule’ or ‘Global Gag Rule.’ 

Previously, practice within the United States had not been specifically restricted or targeted by these rules. Evidence-based medicine has well-established that our youth strongly benefit from gender affirming care options and are at higher risk of suicide and depression when these measures are not available. Not only are our youth at risk with this measure, but this strategy can and will be used again to winnow down the practice of medicine.  The Mexico City rule has long and restricted access to US funds for healthcare providers that also provide abortion since 1984.  This month it was amended to include gender affirming care and DEI ideology.   

Public comment in the United States is an important way for medical professionals to make their opinions known to policymakers. Public comment on these two amendments is allowed until Feb. 17, 2026.  If you would like to leave public comment on these amendments before they become law, you may do so here