CMS proposes rules cutting federal Medicaid/CHIP funding for youth gender-affirming care and conditioning hospital participation

CMS issued two proposed rules: (1) a Medicaid/CHIP rule prohibiting federal financial participation for puberty blockers, hormone therapy, and surgeries for gender-affirming purposes for beneficiaries under 18 (through 18 for CHIP) — CMS itself estimated only about $31 million in 2023 Medicaid spending on such services; and (2) a hospital Conditions of Participation rule that would bar the roughly 4,832 Medicare/Medicaid-certified hospitals from providing these services to minors regardless of payer, on pain of losing Medicare/Medicaid participation — converting federal program funding into a lever against even privately paid care, affecting an estimated 8,570 young people annually. The agency-policy detail is covered in section 2; the items appear here as the funding mechanism replacing the enjoined EO 14187 grant cutoff. (See also sections 2, 13.)