Gender Care Pullback Led by Trump’s HHS Moves Boldly Into 2026

Threats of federal funding cuts to hospitals providing gender-affirming care to minors capped a year of sweeping Trump administration actions over transgender health and set the stage for more in 2026.

On his first day back in office, President Donald Trump ordered his administration to only recognize two sexes, a move that set the tone for key moves by the US Department of Health and Human Services.

Under Secretary Robert F. Kennedy’s leadership, the HHS has issued guidance with sex definitions, rescinded Biden administration guidance on how it interpreted the Affordable Care Act to prohibit gender identity discrimination, and issued a critical review of gender-affirming treatment, claiming there’s “very weak evidence of benefit” of medical interventions for adolescents and children with gender dysphoria.

In December, the HHS proposed rulemaking to no longer provide Medicare and Medicaid funding to hospitals providing gender-affirming care for minors. The plan comes at a contentious time for transgender rights in health care, with judges, the Trump administration, and lawmakers taking steps seen as placing treatment out of reach for minors.

“I’m surprised honestly by just how bold the action was here at the end of the year,” said Jay Richards, research fellow at the Heritage Foundation, the conservative group behind the Project 2025 policy proposals, which included scaling back transgender protections.

“I almost feel like we’re about two years ahead of schedule from what I was actually expecting would have happened based on natural pacing of policy progression,” Richards said.

On the other side of the issue is Lambda Legal, a frequent foe to the Trump administration over gender-affirming care issues.

Sasha Buchert, a senior attorney with Lambda, said she wouldn’t be surprised if 2026 was “an ongoing assault” on transgender people by the Trump administration, which also serves as a distraction from the economy and other issues as “millions of Americans are expected to lose subsidies and their health-care plans.”

“It’s not going to surprise me at all once they start targeting adults,” Buchert said. She said Lambda plans to see the HHS in court over the December Medicaid proposals.

‘Overtly Hostile’

The Trump administration’s actions over transgender health extend beyond the HHS.

Previously, the Department of Justice subpoenaed the Children’s Hospital of Philadelphia and other providers for records tied to the provision of gender-affirming care.

Attorney General Pam Bondi had issued a memo in April calling on US attorneys to go after and prosecute cases of gender-affirming care. That was followed by Brett Shumate, head of DOJ’s civil division, directing employees “to prioritize investigations of doctors, hospitals, pharmaceutical companies, and other appropriate entities.”

The Federal Trade Commission also turned its attention to transgender issues, requesting public comment on gender-affirming care for minors.

“The Trump administration obviously has been overtly hostile to the civil rights of LGBTQ+ populations and to gender-affirming care specifically. And that has played out in a number of ways,” said Nicole Huberfeld, law professor at Boston University.

For example, Huberfeld noted the Trump administration called for the HHS’ National Institutes of Health to no longer cover research on sexual minorities and the Centers for Disease Control and Prevention removing information on gender-affirming care.

“There’s all these ripple effects” that “will magnify the research and data loss” in the months ahead, Huberfeld said.

Huberfeld said she thinks there could be “more concrete regulatory guidance” on how the HHS will view Section 1557 of the ACA—a provision the Biden administration claimed blocked health-care discrimination against transgender people.

“We’re living in a strained environment for medicine, where states and the federal government are criminalizing certain kinds of care regardless of the medical science,” Huberfeld said.

Enforcement Action

The HHS hasn’t shied away from using enforcement action to limit what it calls “gender ideology.”

In August, the Trump administration announced it was stripping federal education funding from California for its refusal to remove gender information from its sex education materials. Prior to that, the HHS accused Maine of violating federal law by allowing males to compete in women’s sports.

Given its focus on gender-affirming care, the Trump administration is likely to return to the issue, said Carmel Shachar, a Harvard law professor. That includes looking at whether people are still accessing gender-affirming care services, and whether “any loopholes” can be closed, Shachar said.

The HHS’ most recent actions to curb federal dollars for gender care “certainly build an agenda saying the government should not pay for gender-affirming care for minors. But even more so than that, gender-affirming care for minors should not happen period.”