Marketplace Integrity and Affordability proposed rule would strip "sex-trait modification" from essential health benefits
- Date
- Actor
- CMS / HHS
- Agency
- Centers for Medicare & Medicaid Services (CMS)
- Type
- Proposed rule
Summary
CMS proposed (90 FR, doc. 2025-04083) to prohibit ACA issuers from covering "sex-trait modification" procedures as essential health benefits beginning plan year 2026 — the first use of that neologism in federal rulemaking — alongside unrelated marketplace-integrity provisions. Removing EHB status strips the care of the ACA's annual/lifetime-limit and cost-sharing protections and forces states mandating coverage to defray costs.
Status
Finalized June 20, 2025 (see 2025-06-20 item); the EHB exclusion was vacated by the District of Massachusetts on August 14, 2026.
As recorded in the data of . Check the sources for anything newer.
Related litigation
Documents
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Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability
Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability, 90 Fed. Reg. 12,942 (proposed Mar. 19, 2025) (to be codified at 45 C.F.R. pts. 147, 155, 156).
Sources
- cms.gov/newsroom/fact-sheets/2025-marketplace-integrity-and-affordability-propo…(opens another site)
- federalregister.gov/documents/2025/03/19/2025-04083/patient-protection-and-affo…(opens another site)
Cite this action
Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability, 90 Fed. Reg. 12,942 (proposed Mar. 19, 2025) (to be codified at 45 C.F.R. pts. 147, 155, 156).
Short form: 90 Fed. Reg. at 12,942.