The CMS is demanding hospitals that offer gender-affirming care for children turn over financial information and clinical protocols related to the services, in an escalation of the Trump administration’s efforts to restrict healthcare for the transgender community.
Administrator Dr. Mehmet Oz gave unnamed “select” hospitals 30 days to respond to the probe, warning in a press release that he would not “turn a blind eye” to procedures that the he says lack a “solid foundation of evidence.”
In letters sent Wednesday, the CMS asked the hospitals to provide “complete financial data for all pediatric sex trait modifications” paid for by the government. Regulators also want hospitals to detail their informed consent policies for youth gender-affirming care procedures, how they document adverse events and how they plan to update care guidance to align with the administration’s view of best practices.
On the same day, HHS Secretary Robert F. Kennedy Jr. sent a letter to healthcare providers and medical boards imploring them to update treatment protocols for youth with gender dysphoria to “ensure that our nation’s children are protected from harm.”
Both the CMS and HHS letters cite a controversial literature review, published by the HHS at the direction of President Donald Trump earlier this month, that claims gender-affirming care offers little benefit to patients and carries serious risk of long-term harm.
The literature review’s findings have been contested by academics, pediatricians and medical groups, who take issue with its anonymous authorship and warn the Trump administration is seeking to put its political agenda over science.
At the time of the review’s publication, HHS specifically said the document was “not a clinical practice guideline.” However, the government is now asking hospitals to audit and modify their policies regarding gender-affirming care for children in light of the review.
Kennedy urged providers to rely more heavily on psychotherapy as a treatment for youth gender dysphoria instead of puberty blockers, hormone therapy or surgery. Meanwhile, Oz requested documentation for how hospitals plan to update their care protocols to align with the review.
Asking providers to change their gender-affirming care practices is an attempt to strong-arm hospitals away from best practices, said Kellan Baker, executive director of the Institute for Health Research and Policy at Whitman-Walker.
“This ‘request’ is a blatant attempt to intimidate providers into betraying their professional obligation to care for their patients,” Baker said over email.
Arjee Restar, a social and legal epidemiologist at Yale University, is also worried about how the probe could impact services.
“This letter sends a regulatory signal that could discourage hospitals from continuing or expanding gender-affirming care — not because the care is unsafe, but because they fear surveillance,” she said. “Subjecting care that is evidence-based to punitive oversight risks undoing years of clinical and public health progress.”
The Trump administration has been targeting pediatric gender-affirming care since January, when the president issued an executive order seeking to ban federal insurance programs from covering the care. Since then, multiple providers have ceased offering such services, including Children’s Healthcare of Atlanta, Penn State Health, UPMC and Lurie Children’s Hospital of Chicago.
On Thursday, Penn Medicine announced it too would halt gender-affirming surgeries for those under 19, citing guidance from the federal government.
“This is a difficult decision that we know impacts patients and families who place their trust in our care teams,” said PJ Brennan, Penn Medicine’s chief medical officer, in a statement. “We remain deeply committed to ensuring a respectful and welcoming environment for all members of the communities we serve and providing comprehensive medical and behavioral health care and psychosocial support for LGBTQ+ individuals while complying with federal government requirements.”
Experts are frustrated with what they view as attacks on gender-affirming care and a backslide in access to scientifically-validated treatments.
“It’s scientifically inappropriate for a federal agency to base clinical oversight on an anonymous, non-peer-reviewed document,” Restar said. “Existing peer-reviewed studies consistently show that gender-affirming care improves mental health and reduces suicidality in trans youth. That’s the evidence CMS should be drawing from.”
The American Medical Association, American Psychological Association and the American Academy of Pediatrics, for example, have all independently endorsed gender-affirming care as viable treatments.
When HHS released its review earlier this month, AAP President Susan Kressly expressed dismay, stating the document “misrepresents the current medical consensus and fails to reflect the realities of pediatric care.”
Just this week, gender-affirming care received support from an unlikely party — the state of Utah, which commissioned a literature review on the subject more than two years ago to determine whether to uphold its moratorium on the treatments for children.
The more than 1,000-page literature review finds evidence that youth gender-affirming care services reduced suicidality, psychological and social harms for patients.
“The conventional wisdom among non-experts has long been that there are limited data” on pediatric care, the authors wrote. “However, results from our exhaustive literature searches have lead us to the opposite conclusion.”
