CMS-3481-P is a proposed rule from the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS) titled “Medicare and Medicaid Programs; Hospital Condition of Participation: Prohibiting Sex-Rejecting Procedures for Children.” It was published in the Federal Register on December 19, 2025, with a public commentdeadline of February 17, 2026. 

What the rule would do:

• Revise the Conditions of Participation (CoP) for hospitals that participate inMedicare and Medicaid (almost all) by prohibiting those hospitals from performing “sex-rejecting procedures” for individuals under age 18 or else lose its certification and funding.

Definition of “sex-rejecting procedures:”

The term is open to wide interpretation but includes pharmaceutical or surgical medical interventions intended to align a minor’s body with a gender other than their sex assigned at birth — including puberty blockers, hormones, and surgeries.

Government rationale:

CMS and HHS state the change is to “protect the health and safety of children” based on their own review of recent “studies.”

Effects on barriers to care:

• Hospitals that offer gender-affirming care as part of their services — even if paid for with private insurance, state funds, or cash — could choose to discontinue care entirely to avoid jeopardizing Medicare/Medicaid participation and funding.
  

• Providers who specialize in gender-affirming care could choose to leave the state to pursue gainful employment.
  

• Medical providers may stop offering gender-affirming care to minors entirely in order to avoid confusion over federal funding regulations.

What to include in your comment:

• Write about what gender-affirming care has meant to you, personally, as either a trans person, a provider, or an ally.
  

• Emphasize that healthcare is a basic human right, and that everyone deserves access to life-saving care.
  

• Reiterate that decisions about personal health are best left to individuals (and their families) and their providers, not the government.
  

• Explain how it is unconscionable to punish hospitals and providers for offering medical care by threatening their ability to participate in Medicare (CHIP) and Medicaid programs altogether if a single provider treats just one transgender youth, regardless of that patient’s past or present diagnosis, care-plan, the consent of their parents, or their own best interest.
  

• Reiterate that care for trans and gender diverse youth meet evidence-based standards of care, just like other medical treatments that have long been covered by federal programs. Gender-affirming care is real health care. It is safe, effective, and supported by every major medical organization in the United States.
  

• Mention statistics, including: 

  • 33% of trans people avoided health care because they feared mistreatment or discrimination​. 

  • 48% of trans people of color reported being mistreated by a health care provider, including verbal harassment, refusal of treatment, or physical abuse​. 

  • 24% of trans immigrants reported avoiding medical care due to fear of discrimination or deportation​. 

  • Access to gender-affirming care has been shown to significantly reduce suicide risk and improve mental health outcomes​.
    

• Use your own words, and try to keep your opinions and arguments opposing the rule respectful.

Why it’s important to submit a comment:

While you may use comment portals or copy & paste sample comments for convenience, comments submitted through the same link will be counted as one very long comment and identical comments will likely also be less persuasive than unique individual comments. 

• When CMS reviews comments, it groups identical or near-identical submissions together. Ten thousand copies of the same template often get summarized as: “CMS received 10,000 comments opposing the rule expressing similar concerns.” That’s it.
  

• A unique comment must be read, categorized, and substantively addressed on its own. It’s the law – under the Administrative Procedure Act, CMS must respond to significant comments.
  

• Your comments may raise new arguments, evidence, legal concerns, implementation problems, or real-world impacts that other comments did not completely address.
  

• You are helping build a record for litigation. Your unique personal comment will help show: CMS was warned about the harms of these proposed rules; CMS understood the harms and proceeded anyway; CMS was presented with alternatives to the proposed rules; CMS is biased against individuals with a specific medical condition (those seeking “sex-rejecting procedures”) and clearly proposed these rules to prevent them from accessing appropriate healthcare with no valid compelling state interest.

You can submit a comment online anonymously, or you can send a comment by regular U.S. mail (however it must be received by the deadline) to:

Centers for Medicare & Medicaid Services

Department of Health and Human Services

Attn: CMS-2451-P, CMS-3481-P

P.O. Box 8016

Baltimore, MD 21244-8016

CMS-2451-P is a proposed rule from the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS) titled “Medicaid Program; Prohibition on Federal Medicaid and Children’s Health Insurance Program Funding for Sex-Rejecting Procedures Furnished to Children.” It was published in the Federal Register on December 19, 2025, with a public comment deadline of February 17, 2026.

What the rule would do:

• Prohibit Federal funds from being used to cover so-called “sex-rejecting procedures” for individuals under age 18 enrolled in Medicaid.
  

• Prohibit Federal funds from covering so-called “sex-rejecting procedures” for individuals under age 19 enrolled in CHIP.

States would still be allowed to fund such care with state dollars if they choose.

Definition of “sex-rejecting procedures:”

The term is open to wide interpretation but includes pharmaceutical or surgical medical interventions intended to align a minor’s body with a gender other than their sex assigned at birth — including puberty blockers, hormones, and surgeries.

Government rationale:

CMS states in the proposal that the medical evidence on these procedures for minors is not conclusive and may carry risks, and that prohibiting federal funding is consistent with quality of care standards — that is not true.

Effects on barriers to care:

• If finalized, providers may face fewer resources or funding to deliver gender-affirming care to minors covered by Medicaid/CHIP.
  

• Families who rely on federal coverage might have to seek state-only coverage, private insurance, or pay out-of-pocket for care that is otherwise a recognized standard of care for gender dysphoria in minors.
  

• Medical providers may stop offering gender-affirming care to minors entirely in order to avoid confusion over federal funding regulations.

What to include in your comment:

• Write about what gender-affirming care has meant to you, personally, as either a trans person, a provider, or an ally.
  

• Emphasize that healthcare is a basic human right, and that everyone deserves access to life-saving care.
  

• Reiterate that decisions about personal health are best left to individuals (and their families) and their providers, not the government.
  

• Explain how it is unconscionable to punish hospitals and providers for offering medical care by threatening their ability to participate in Medicare (CHIP) and Medicaid programs altogether if a single provider treats just one transgender youth, regardless of that patient’s past or present diagnosis, care-plan, the consent of their parents, or their own best interest.
  

• Reiterate that care for trans and gender diverse youth meet evidence-based standards of care, just like other medical treatments that have long been covered by federal programs. Gender-affirming care is real health care. It is safe, effective, and supported by every major medical organization in the United States.
  

• Mention statistics, including: 

  • 33% of trans people avoided health care because they feared mistreatment or discrimination​. 

  • 48% of trans people of color reported being mistreated by a health care provider, including verbal harassment, refusal of treatment, or physical abuse​. 

  • 24% of trans immigrants reported avoiding medical care due to fear of discrimination or deportation​. 

  • Access to gender-affirming care has been shown to significantly reduce suicide risk and improve mental health outcomes​.
    

• Use your own words, and try to keep your opinions and arguments opposing the rule respectful.

Remember to also submit a comment on the companion proposed rule CMS-3481-P!

TAKE ACTION: The public comment period for both rules are OPEN. 

You can make your voice heard if you have capacity. Urge HHS to drop the rules at the links below:

• Information to help with your comments: https://transequality.org/news/act-now-protect-our-healthcare

• Comment through HRC’s Portal: https://act.hrc.org/page/183931/-/1

• Comment Directly: https://www.federalregister.gov/documents/2025/12/19/2025-23465/medicare-and-medicaid-programs-hospital-condition-of-participation-prohibiting-sex-rejecting

Health Secretary RFK Jr. and Dr. Oz unveil new restrictions on gender-affirming transitional care for minors receiving Medicare or Medicaid. 

READ THE REDACTED TRASCRIPT HERE

Read the nonredacted transcript HERE: all lies have been redacted

Nonredacted transcript and video from 1/5/26: https://www.rev.com/transcripts/restrictions-on-gender-affirming-care-for-minors