In a move that could further reduce gender-affirming care for minors in Illinois, the federal government is proposing rules that would strip Medicare and Medicaid funding from hospitals that provide such services.
The administration of President Donald Trump has been threatening since early this year to block federal funding for hospitals that provide gender-affirming care to people younger than 18. The proposal announced Thursday is a concrete step toward making good on those threats.
The specter of losing federal funding already drove some Chicago area hospital systems to scale back on their gender-affirming care for minors. Medicare and Medicaid are huge sources of funding for most hospitals. UChicago Medicine stopped providing gender-affirming pediatric care this summer, and Advocate Health Care said in August it would no longer provider gender-affirming medications to patients younger than 19.
A few Chicago area hospital systems, however, have held out. Lurie Children’s Hospital and UI Health halted gender-affirming surgeries for minors earlier this year but continued providing other types of gender-affirming care. Rush University System for Health stopped offering hormonal care to new patients under the age of 18 this summer.
Gender-affirming care can include a range of services such as puberty blockers, which are medications that delay puberty; hormone therapy, which can help individuals develop male or female characteristics; and surgeries to remove the breasts or alter genitals.
The federal proposals would block Medicare and Medicaid funding from hospitals performing any of those services for people younger than 18. It would also bar federal Medicaid dollars from being used for such services.
“Under my leadership, and answering President Trump’s call to action, the federal government will do everything in its power to stop unsafe, irreversible practices that put our children at risk,” said Robert F. Kennedy, Jr., secretary of the U.S. Department of Health and Human Services, in a news release. “This Administration will protect America’s most vulnerable. Our children deserve better — and we are delivering on that promise.”
Representatives for Lurie, Advocate and Rush were not able to immediately provide comment Thursday morning.
Illinois Attorney General Kwame Raoul was swift Thursday to blast the news – while emphasizing that the proposals are not yet final, meaning young patients in Illinois can still receive gender-affirming care and health care professionals can still provide it.
Raoul said in a news release his office is evaluating the proposed rules and is “prepared to pursue every avenue to prevent the proposed rules from taking effect.”
“The Trump administration is taking this callous step to deny access to medically necessary health care for transgender youth,” Raoul said in the news release. “These proposed rules, if finalized, would have a devastating impact on the patients who need this health care and the providers who have continued to serve them.”
The proposed rules could lead to kids losing access to their medical care, said Asher McMaher, executive director of nonprofit advocacy group Trans Up Front Illinois.
The advocacy group has spent much of the last year helping families with children who are transgender find gender-affirming care, as Illinois hospitals have scaled back and, in some cases, stopped offering the services.
There are now about 29 practices in Illinois – many of them independent and operating on membership models – that still offer hormonal therapy to minors, McMaher said. About one-third of those are in the Chicago area, McMaher said. Only about six or seven practices in the state still offer puberty blockers, McMaher said.
“They’re trying to weaponize federal funding against the trans community despite the fact the trans community makes up 1% of the public,” McMaher said. “This attack on youth, it just shows how hateful this administration is in that they’re not doing this for the protection of children. They’re doing this out of bigotry, they’re doing this out of phobias. They doing this while hiding behind religious beliefs or political affiliations.”
The federal government also released a public health message Thursday saying that current evidence does not support claims that puberty blockers, hormones and surgeries are safe and effective treatments for pediatric gender dysphoria. That message was issued following the November release of a report by the U.S. Department of Health and Human Services on treatments for gender dysphoria.
Meanwhile, a number of other studies in recent years have shown improved mental health for transgender and gender diverse youth who receive gender-affirming care. Advocates for the care say it is medically necessary and can be life-saving. The American Academy of Pediatrics supports access to gender-affirming care for minors.