“Live free or die” has to be the absolute coolest state motto in the Union.
Which is why it’s completely unsurprising that four families of trans kids in New Hampshire are suing the Trump administration over a change to Medicaid rules that will block gender-affirming care for minors.
The suit was filed last Thursday, on October 1, in federal court. The four families named as plaintiffs are represented by GLAD Law, the National Center for LGBTQ Rights, and the ACLU of New Hampshire, and their stated goal is to stop the rule from taking effect on October 13, just under a week away.
“These families made medical decisions with their doctors, based on careful assessment of their children’s individual medical needs,” said Chris Erchull, Senior Staff Attorney, GLBTQ Legal Advocates & Defenders. “On October 13, the Trump administration wants to pull the funding for their care mid-treatment, with no plan for what happens to them. We’re asking the court to act quickly so these families don’t lose the medical care that has enabled their kids to thrive.”
The rule, published by Centers for Medicare & Medicaid Services, will “[end] federal taxpayer funding for sex-rejecting procedures on children,” according to Secretary for the Department of Health and Human Services, Robert F. Kennedy, Jr. The language surrounding this new rule is plainly transphobic and particularly odious, considering the “sex-rejecting procedures” (an incredibly loaded, inaccurate description) currently funded by Medicaid and CHIP are safe, supported by overwhelming scientific evidence, and proven effective for mitigating gender dysphoria in young transgender people.
When it comes to trans youth, services covered by Medicaid typically include puberty blockers or hormone replacement therapy, and very rarely chest surgeries like mastectomies for transmasculine people. Largely, these are non-invasive, reversible treatments. More permanent changes typically take place after somebody has turned 18.
And yet, CMS Administrator Dr. Mehmet Oz, who does hold a medical license but has long promoted dangerous pseudoscience, said, “Children deserve our protection, not experimental interventions that pose serious risks and convey no proven benefits. By cutting off federal funds for these sex-rejecting procedures, we’re following the science, saving taxpayer dollars, and, most importantly, protecting children from potentially irreversible harm so they can truly flourish.”
They, of course, are not following the science. There is no evidence (except, perhaps, the false evidence they created to justify decisions like these) that these interventions are harmful or pose any risks. We’ve been treating cisgender kids for precocious puberty since the 1980s, and trans kids for gender dysphoria since the 1990s, with absolutely no noteworthy adverse effects. We also have significant evidence to suggest that these treatments do help.
We know that trans youth typically understand their gender identity very well, and rarely change their minds or regret medical transition. When they do change their minds, they typically move from one gender variant identity to another (e.g., from expressing themselves as a binary transgender girl to gender fluid or agender), rather than reinhabiting their gender assigned at birth. This rule change, in my opinion, has been done with intentional malice, to harm the trans community as a part of Donald Trump’s vitriolic, bigoted war against us, and for no other purpose. Certainly not because of any scientific facts.
The change threatens real harm to vulnerable people, too. Dr. Frances Lim-Liberty, a New Hampshire physician, told the ACLU, “The families I see are very worried about this rule going into effect. These are parents who have, over the course of years, worked with their children’s doctors to understand the best path of care for their child’s individual needs. We are talking about families who are already under tremendous financial strain, and now they are facing the prospect of that care being ripped away—critical medications for their children’s development, health, and wellbeing.”
Karla Koe, one of the parents listed as a plaintiff (under a pseudonym), said, “If this rule goes into effect, I don’t know what options we will have to pay for our daughter’s continuing care. Kylie’s father and I are worried sick about what will happen to her.”
The ACLU’s arguments against the rule change are clear and persuasive. First, Congress has never vested in the Executive Branch the authority to make changes like this. Second, it violates Medicaid regulations, which state that a patient cannot be denied coverage because of a diagnosis; because cis kids can still receive blockers for precocious puberty under Medicaid rules, but trans kids cannot receive them for gender dysphoria, this is a clear violation of existing regulations. Finally, according to the ACLU, over 90% of the 11,000 comments CMS received on the rule change opposed the rule; federal agencies must engage substantively with these kinds of public reactions, but they are going ahead with the change regardless.
This rule change will severely harm low-income families of trans kids, and that is unacceptable. Let’s hope that these plaintiffs are able to receive injunctive relief, and that it can be applied to families nationwide. If not, the rule goes into effect next Tuesday, with a grace period of six months for trans kids to “taper off” of their safe, necessary, effective medical treatments as a result of targeted attacks from the federal government.
