08/27/2026
A new federal rule will cut Medicaid and CHIP funding for gender-affirming care for children, and a post from Rep. Nancy Mace has pushed the issue back into the spotlight.
The rule applies to minors covered by the two programs, meaning under 18 for Medicaid and under 19 for CHIP. It covers puberty blockers, hormone therapy and surgery, although surgery for minors is rare.
It is scheduled to take effect on October 13. Children who are already receiving hormone therapy will have six more months of continued federal funding. Mental health coverage is not affected.
States can still choose to pay for these services using their own budgets, but federal funding will no longer be available for them under the rule.
Regulators estimate the change will save about 235 million dollars over ten years across programs that cover 35.5 million children. Officials also wrote that saving money was not the goal of the rule.
The agency received nearly 35,000 public comments. Of the comments it published, it said more than 90 percent opposed the change.
The rule relies on a 2025 federal health review. The American Academy of Pediatrics has said that review misstates the medical consensus, showing how sharply divided the debate remains between federal officials, medical groups, states, families and lawmakers.
Medicaid and CHIP are major sources of health coverage for low-income children in the United States, which is why changes to what they will and will not fund can have effects far beyond one medical category.
How do you think decisions like this should be made, by federal agencies, states, doctors, parents, or some combination?
Sources: CMS; KFF
