An HHS proposed rule entitled "Medicare and Medicaid Programs; Hospital Condition of Participation: Prohibiting Sex-Rejecting Procedures for Children" prohibits hospitals participating in Medicare and Medicaid from providing most services to treat gender dysphoria in children, including puberty blockers, opposite-sex hormones, and sex reassignment surgery.[1][2][6] The exceptions apply only to medically verifiable disorders of sexual development or complications from previous procedures.1][2] The second proposed rule prohibits federal Medicaid funding for "sex-rejecting" care for patients under 18 and reimbursement through the Children's Health Insurance Program for patients under 19.[2][3][7] These measures were announced on December 18, 2025, and are open for public comment for 60 days.[2][3] Currently, 27 states do not provide Medicaid coverage for such procedures in children.2 The rules are based on a Section 5 executive order that mandates steps by HHS to eliminate gender-affirming care in adolescents through conditions of participation in Medicare and Medicaid.