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One advocate said the proposed rule would force hospitals "to choose between providing lifesaving care for trans people or maintaining the ability to serve patients through Medicare and Medicaid."
A pair of extreme new Trump administration rules aimed at functionally banning gender-affirming healthcare for transgender youth could force even more hospitals to close down.
NPR reported Thursday that the Department of Health and Human Services (HHS) drafted a proposed rule that would prohibit federal Medicaid reimbursement for medical care provided to transgender patients younger than 18 and prohibit the same from the Children's Health Insurance Program (CHIP) for patients under 19.
Another proposed rule goes even further, blocking all Medicaid and Medicare funding to hospitals that provide gender-affirming care to youth.
As Erin Reed, an independent journalist who reports on LGBTQ+ rights, explained, this "would effectively eliminate access to such care nationwide, except at the few private clinics able to forgo Medicaid entirely, a rarity in transgender youth medicine."
The policies are of a piece with the Trump administration and the broader Republican Party's efforts to eliminate transgender healthcare for youth across the country.
Bans on gender-affirming care for those under 18 have already been passed in 27 states, despite evidence that early access to treatments like puberty blockers and hormones can save lives.
As Reed pointed out, a Cornell University review of more than 51 studies shows that access to such care dramatically reduces the risk of suicide and the rates of anxiety and depression among transgender adolescents.
The new HHS rules are being prepared for public release in November and would not be finalized for several more months.
But if passed, the ramifications could extend far beyond transgender people, impacting the entire healthcare system, for which federal funding from Medicare and Medicaid is a load-bearing piece. According to a report last year from the American Hospital Association, 96% of hospitals in the US have more than half their inpatient days paid for by Medicare and Medicaid.
It is already becoming apparent what happens when even some of that funding is taken away. As a result of the massive GOP budget law passed in July, an estimated $1 trillion is expected to be cut from Medicaid over the next decade. According to an analysis released Thursday by Protect Our Care, which maintains a Hospital Crisis Watch database, more than 500 healthcare providers across the country are already at risk of shutting down due to the budget cuts.
Tyler Hack, the executive director of the Christopher Street Project, a transgender rights organization, said that the newly proposed HHS rule would be "forcing hospitals to choose between providing lifesaving care for trans people or maintaining the ability to serve patients through Medicare and Medicaid."
"Today’s news marks a dangerous overreach by the executive branch, pitting trans people, low-income families, disabled people, and seniors against each other and making hospitals choose which vulnerable populations to serve," Hack said. "If these rules become law, it will kill people."
The New York City Council Progressive Caucus endorses a landmark legislative package of youth priorities: “a road map for our youth movements in cities everywhere.”
In New York City, things seem to be falling apart. Prospect Park and Van Cortland Park are on fire; 6-year-old students, high school seniors, and college students are being detained and deported by Immigration and Customs Enforcement; gender-affirming care remains out of reach for many, and trans hate is escalating.
This is our future under governments led by the likes of New York City Mayor Eric Adams and President Donald Trump. It’s one of fear, climate disaster, fascism, genocide, unaffordability, and violence. It’s not one we will accept.
That’s why this September, dozens of New York City youth organizations, New York City Council members, and 150 youth leaders came together to chart a new vision for our interconnected movements, unveiling the Livable Future Package. Now, the New York City Council Progressive Caucus, a 17-member bloc of elected officials, joins our campaign centered on the four most urgent crises facing New York City youth.
The priorities include 1) the NYC Trust Act, which will strengthen enforcement of our sanctuary city laws. 2) Intro 1180 to lower utility bills and hold ultra-wealthy landlords accountable by enforcing our landmark 2019 climate and energy efficiency law. 3) The Community Opportunity Purchase Act, which will give community organizations the first chance to purchase buildings, providing youth communities a pathway to stable housing over corporate speculation. Lastly, 4) City G.I.R.D.S. and a companion bill to make sure that young trans, non-binary, intersex, and gender-nonconforming New Yorkers in the jail and prison systems have access to housing decisions aligning with their identity and to gender-affirming medication and items.
“We grew up in New York. We want to stay here, and I want to be proud of the place I am from.”
This is a model for a city government that stands up for our generation in the face of fascism and won’t back down from the fight for a city we can afford.
The Livable Future coalition spans both traditional movement divides and the five boroughs. Our coalition, from middle schoolers to young adults newly entering the workforce to sitting NYC Council members, collectively shares in the belief that a livable future is possible. Our future is not just 100 years into the future; it’s 2026, 2030, and every minute in between.

Our campaign presents a road map for our youth movements in cities across the country. From New York City to Los Angeles, Chicago to DC, and Houston to Philadelphia, we can and we must organize our cities as fortresses against encroaching oligarchical fascism.
Leaders across New York City have already taken note of our organizing, joining us at our launch event in September and for rallies outside City Hall.
As youth-leader Emma Rehac of Youth Alliance for Housing said at one of these events, “We grew up in New York. We want to stay here, and I want to be proud of the place I am from.”
“The Livable Future Package is about ensuring New York is a city that stands up for all our communities. We deserve to afford to grow old in the neighborhoods we grew up in, to live in a place that defends against detention and deportation—somewhere that takes action to fight the climate crisis and for affordability, and ensures our basic human rights are protected no matter our gender identity.”
Our work on the package is just beginning. The Council, led by Speaker Adrienne Adams, and the mayor have a choice.
Will they stand by as our city capitulates to Trump? As ICE floods our schools, and our future disappears? Or, will they join us and pass the Livable Future Package by the end of the year?
We hope they will help us build a city that stands up, that fights back, and charts a livable, affordable future for the next generation.
"The district has made clear it will not fold quietly, signaling that some institutions still have the resolve to stand against a federal campaign of erasure," wrote one LGBTQ+ rights journalist.
As educational institutions around the country capitulate, Denver's public school system said Tuesday that it would defy demands from the Trump administration to discriminate against transgender students even if it means losing federal funds.
Alex Marrero, the superintendent of Denver Public Schools (DPS), said the school "will protect all of their students from this hostile administration," by refusing to implement a ban on gender-neutral bathrooms mandated by Trump's Department of Education.
On Thursday, the department's Office for Civil Rights (OCR) sent Denver Public Schools an email demanding that the school remove a multi-stall, gender-neutral restroom at one of its high schools, which it claimed violated Title IX of the Civil Rights Act.
As Erin Reed, an independent journalist who covers LGBTQ+ rights, notes, the facility built by DPS and other schools is "similar to facilities in major airports, European cities, and increasingly across the United States." The school, meanwhile, has said that the facility was requested by students themselves and has 12-foot high partitions to protect their privacy.
The OCR went further. To be compliant with Title IX, it said, the school also had to "adopt biology-based definitions for the words 'male' and 'female'," meaning they needed to classify transgender students by their biological sex at birth rather than their preferred identities, including banning them from restrooms that do not correspond to their biological sex.
The Trump administration also called on the school to eliminate components of its "LGBTQ+ Toolkit," which includes guidance on how students and faculty can create a welcoming environment for their trans peers. Among other things, the document encourages members of the school community to step in to stop bullying of LGBTQ+ students, respect the preferred pronouns of all students, and for faculty to enforce dress codes in a gender-neutral way.
As Reed put it, the department was effectively "claiming that Title IX actually mandates discrimination against transgender students."
If DPS refused to comply within 10 days, the department threatened to strip the district of federal funding, which makes up 7% of the school's annual budget, according to Chalkbeat. A large portion of that federal money goes toward low-cost school lunches for poor children.
In a statement issued Tuesday, DPS's school board and administration put out a statement "disagreeing unequivocally" with the government's interpretation of the law.
"Title IX permits schools to provide sex-separate restrooms. It does not require that to be the only option," DPS argued. "The interpretation put forward by OCR would undercut our equity commitments, contradict our mission, harm the very students we are entrusted to support, and would have a devastating impact on East High School and the broader LGBTQ+ community. What matters most is that students are safe, have privacy, and can learn without fear."
"The decision to implement gender-neutral restrooms at East followed direct feedback from LGBTQ+ students who reported they did not feel safe," the statement continued. "For these students, access to a restroom where they feel secure is not symbolic. It is about dignity, health, and the ability to learn. When students speak, we listen and we act."
Superintendent Marrero, meanwhile, put out a short video on Instagram expressing his support for the district's LGBTQ+ students.
"As you might have seen in the news, the federal government has decided to take a firm stance and have us roll back our support to the LGBTQ+ community, and of course, we're not having it," Marrero said. "We will continue to stand in solidarity, and as you engage this weekend and beyond, I just wanted to let you know that we got you, and everything is going to be ok."
In a statement published alongside the video, Marrero wrote: "We will fight. In the courts, if we must. In the public square, when necessary. Always in partnership with those who believe that every student deserves to show up to school ready to learn, free from fear."
With this pledge to stand by its LGBTQ+ students, DPS joined five school districts in Virginia that last month responded with similar defiance when the Trump administration ordered them to stop allowing trans students to use bathrooms matching their gender. Those districts—which include Loudoun, Arlington, and Fairfax Counties—have launched a lawsuit against the Trump administration to keep their federal funding.
"Elite institutions like Brown, Columbia, and Penn—as well as multiple hospitals serving transgender youth—have already capitulated, signing away protections through bathroom and sports bans or cutting off medical care entirely," Reed wrote. "Denver Public Schools, by contrast, has drawn a line. With the Department of Education's deadline looming next Monday, the district has made clear it will not fold quietly, signaling that some institutions still have the resolve to stand against a federal campaign of erasure."