Jun 13 Reconciliation Bill Bans Gender-Affirming Care Through Medicaid for Youth and Adults

(June 13, 2025)

Last month, Allies for Children published a blog covering the Budget Reconciliation bill which was passed by the House of Representatives in May. This bill, which has since become known as the “One Big Beautiful Bill Act,” proposes cuts of more than $715 billion to Medicaid and to other programs that our country’s most vulnerable populations rely upon. Just hours before the bill was passed, a change was made to prohibit Medicaid from providing gender-affirming healthcare. In past versions of the bill, the provision had only targeted trans youth under 18, but the version of the bill that was passed by the House now bans Medicaid from providing gender-affirming care to both youth and adults.

The subject of gender-affirming care for youth has been a divisive topic for a while, particularly as children and youth – both trans- and cisgender – find themselves caught in the crossfire of transphobic rhetoric and policy. Typically, the motivation behind the anti-trans policy proposals, including the federal reconciliation bill and bills introduced at the state level, is the belief that youth who identify as transgender must be “protected” from undergoing irreversible gender-affirming surgeries. This ideology was reflected in one of the President Trump’s early Presidential Actions, which claimed that, “Across the country today, medical professionals are maiming and sterilizing a growing number of impressionable children under the radical and false claim that adults can change a child’s sex through a series of irreversible medical interventions” (emphasis added).

Despite these claims, there is no evidence that American children are receiving any kind of “irreversible” gender-affirming care. In fact, studies have shown that receiving intentional, appropriate, and supportive gender-affirming care can have positive effects on the mental health of transgender youth.

A study at the Harvard T.H. Chan School of Public Health, released in 2024, utilizing health insurance data, found that there were no instances of gender-affirming surgery being performed on youth 12 or younger. And if any surgeries did occur, i.e. breast reduction, it almost always was performed on a cisgender teens aged 15-17.

So if transgender youth are not, in almost all cases, receiving gender-affirming surgeries, what does gender-affirming care look like for youth? According to the American Academy of Pediatrics, “Until the patient is 18 years of age, gender-affirming care generally refers to developmentally appropriate support as the child goes through a social transition (eg, changes in pronouns, names, hairstyles, and/or clothing), puberty blocking treatment, and/or hormone replacement therapy (HRT).” This was also affirmed by Dr. Meredithe McNamara (Yale School of Medicine), who said in an interview with PBS that in addition to social affirmation and transition, “there are medical aspects of gender affirmation too, which can and may include puberty blockers or exogenous sex hormones such as estrogen and testosterone.”

Puberty blockers, the first form of medical intervention that some (but not all) transgender youth may receive, were approved by the FDA in 1993 for use in cases of precocious puberty among cisgender youth. According to sources cited by the Human Rights Campaign, the effects of puberty blockers are completely reversible with “minimal long-term effects, if any.”

As previously stated, receiving appropriate gender-affirming care has been shown to have positive mental health effects for transgender youth. An investigation published by the Journal of the American Medical Association (JAMA) “observed 60% lower odds of depression… and 73% lower odds of suicidality… among youths who had initiated [puberty blockers] or [gender-affirming hormones] compared with youths who had not.” Another study published by the Journal of Adolescent Health also found that receiving gender-affirming hormone treatment led to reduced rates of depression and suicidality when compared to trans youth who did not receive such treatments.

In summary, transgender youth are not being “maimed” by irreversible surgeries. When trans minors choose to receive medical intervention under the care of a physician, it is almost always in the form of puberty blockers and/or hormones. Gender-affirming healthcare is healthcare. Denying trans youth the ability to receive appropriate healthcare by banning Medicaid – which insures roughly 50% of American children and youth – from receiving such care could have major negative effects on both their mental and physical health.

To learn more about the importance of gender-affirming healthcare for trans youth:

Get the Facts on Gender-Affirming Care (Human Rights Campaign)
Further Defining Gender-Affirming Care (AAP Journals Blog)
Debunking common myths about gender-affirming care for youth (PBS News)
Young Children Do Not Receive Medical Gender Transition Treatment (FactCheck.org)
What the Science on Gender-Affirming Care for Transgender Kids Really Shows (Scientific American)

To take action, join Advocates for Trans Equality’s email campaign

Laura Condon, Allies for Children Project Coordinator