Federal investigations and new healthcare rules are changing where and how transgender minors can receive medical care in the United States. On September 18, the U.S. Department of Justice announced agreements with NYU Langone Health and the University of Pittsburgh Medical Center, or UPMC, following investigations into how the hospital systems billed for gender-affirming care provided to minors. Under the agreements, both health systems will stop providing puberty blockers, hormone treatments, and surgical procedures for gender transition to patients under 18. NYU Langone agreed to pay $8.5 million and UPMC $950,000. Both health systems denied wrongdoing or liability, and the Justice Department stated that the allegations had not resulted in a determination of liability.
Gender-affirming care is a broad term that can include mental-health support as well as medical treatment for people experiencing gender dysphoria, which refers to distress that can occur when a person’s gender identity differs from their sex assigned at birth. For minors, medical treatment can include puberty blockers or hormone therapy, while surgeries are much less common. Decisions about what treatment is appropriate have become the subject of major disagreements among government officials, medical organizations, families, and advocacy groups.
The September settlements are part of a wider federal investigation that began after President Donald Trump issued an executive order in January 2025 directing federal agencies to restrict government support for medical gender transition for people under 19. Later that year, the Justice Department announced that it had sent more than 20 subpoenas to doctors and clinics involved in providing such treatment to minors. The department said the investigations involved possible healthcare fraud, false statements, and other violations of federal law.
Some of the subpoenas sought information about individual patients in addition to hospital policies and billing practices, raising disputes over medical privacy. Courts have blocked some of these requests. In June 2026, for example, a federal judge rejected an attempt to stop the investigations nationwide but left in place a decision blocking a subpoena directed at Children’s National Hospital in Washington, D.C. Other hospitals have chosen to reach agreements with the government instead.
Before the NYU Langone and UPMC agreements, the Justice Department had reached similar settlements with Texas Children’s Hospital, Cleveland Clinic, Connecticut Children’s Medical Center, and Mount Sinai Health System. These agreements included commitments to stop providing certain gender-transition treatments to minors. NYU Langone had already ended its transgender youth program in February, citing what it called the “current regulatory environment.”
Access is also changing because of new rules involving health insurance. In August, the Centers for Medicare & Medicaid Services finalized a rule ending federal Medicaid funding for puberty blockers, hormone therapy, and surgeries used for gender transition for patients under 18. The same restriction applies through the Children’s Health Insurance Program, or CHIP, for patients under 19. The rule is scheduled to take effect on October 13, 2026.
The rule does not completely prohibit states from covering these treatments. States can choose to use their own money instead of federal funds, and mental-health counseling for gender dysphoria can continue to receive federal Medicaid and CHIP funding. People already receiving hormone therapy can also receive temporary federal coverage during a six-month transition period. This means access may increasingly depend on where a family lives, how their state responds to the federal rule, and what type of health insurance they have.
The administration says the restrictions are intended to protect minors from treatments whose long-term benefits and risks it considers insufficiently established. The Department of Health and Human Services has argued that federal health programs should not pay for these treatments because of concerns about possible long-term or irreversible effects.
Many major U.S. medical organizations disagree with the federal approach. The American Medical Association has opposed federal rules that restrict gender-affirming care, arguing that medical decisions should be based on evidence and shared decision-making between physicians, patients, and families. At the same time, debate continues over the evidence for particular treatments, especially surgery for minors. The American Society of Plastic Surgeons has said that evidence is insufficient to determine whether the benefits of certain gender-related surgeries for minors outweigh their risks.
The federal changes come on top of state restrictions. By August, at least 27 states had already prohibited some forms of gender-affirming medical care for minors. In states where treatment remains legal, federal investigations, hospital decisions, and changes to Medicaid and CHIP funding can still affect whether families are able to find a provider or afford treatment. As the new federal funding rule approaches its October effective date, transgender minors’ access to medical care increasingly differs depending on their state, healthcare provider, and insurance coverage.
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