Equality Arlington Opposes the U.S. Centers for Medicare and Medicaid Services’ Proposed Ban on Federal Funding for Hospitals Providing Gender Affirming Care for Transgender Youth

Centers for Medicare & Medicaid Services:

We are writing on behalf of Equality Arlington to provide comments regarding the Centers for Medicare and Medicaid Services (CMS) proposed rule, “Medicare and Medicaid Programs; Hospital Condition of Participation: Prohibiting Sex-Rejecting Procedures for Children.” Equality Arlington is a nonprofit advocacy organization dedicated to improving the lives of the LGBTQ+ community in Arlington, Virginia.

We urge CMS to rescind this dangerous and discriminatory proposed rule and maintain a commitment to access to care based on evidence-based clinical standards.

Transgender and non-binary youth residing in Arlington, Virginia deserve access to clinically appropriate care, including care and treatment necessary to treat gender dysphoria. If CMS finalizes this rule, we are concerned that clinically appropriate care will no longer be available at major northern Virginia hospitals. These hospitals will be placed in the no-win position of either complying with illegal and unethical federal restrictions that prohibit them from providing necessary care to transgender and non-binary patients or losing vital federal reimbursement streams needed to keep their doors open.

A recent survey conducted in Arlington County underscores the need to ensure that transgender and non-binary students have access to medically necessary care and treatment. Nearly half of transgender and non-binary students surveyed in 2024 reported mental health struggles, including anxiety and depression.[1] Access to gender affirming care has been found to improve mental health among transgender and non-binary youth.[2] Cutting the legs out from under the care system on which this population depends not only violates federal law, but will harm the very children this Administration purports to be protecting. Decisions about a child’s health care should be left to parents, working in concert with trained clinicians practicing under ethical and clinical guidelines. Emphatically, decisions about clinical care should not be dictated by the federal government.

The proposed rule bases its decision to alter hospital conditions of participation requirements on a purposeful and dangerous rejection of clinical evidence and standards of care for the treatment of gender dysphoria in youth. To justify its proposed rule, CMS relies heavily on evidence reviews conducted by the agency last year as well as a review conducted in the United Kingdom in 2024. However, both of these reviews have been widely criticized and discredited by experts in the field of gender dysphoria.[3] 

Moreover, HHS attempts to directly influence the practice of medicine—contrary to section 1801 of the Social Security Act and commonsense—by conditioning participation in Medicare and Medicaid reimbursement on blind allegiance to political ideology over clinical evidence and decision making. This type of overreach has no place in federal health policy. CMS maintains that the proposed rule is legal under Section 1801 because the medical interventions at issue do not constitute healthcare when applied to children, but such an interpretation contradicts years of peer-reviewed research finding that access to gender affirming care is clinically appropriate for the treatment of gender dysphoria in transgender and non-binary youth.

This proposed rule represents yet another encroachment into the rights of states to regulate their health care programs, the rights of parents to work with clinicians to determine the best care for their children, and the rights of providers and hospitals to practice medicine in accordance with ethical and clinical standards of care. For all of the reasons stated above, we urge CMS to rescind this discriminatory and illegal rule.  

Thank you for the opportunity to comment. Please reach out to Equality Arlington President, Kellen MacBeth for questions (board@equalityarlington.org).

Sincerely,

Kellen MacBeth

President, Equality Arlington

[1] Arlington Public Schools, 2024 Arlington Youth Survey, https://www.apsva.us/wp-content/uploads/sites/57/2025/11/2024-AYS-report-FINAL.pdf

[2] Tordoff DM, Wanta JW, Collin A, Stepney C, Inwards-Breland DJ, Ahrens K. Mental Health Outcomes in Transgender and Nonbinary Youths Receiving Gender-Affirming Care. JAMA Netw Open. 2022 Feb 1;5(2):e220978. doi: 10.1001/jamanetworkopen.2022.0978.

[3] Noone C, Southgate A, Ashman A, Quinn É, Comer D, Shrewsbury D, Ashley F, Hartland J, Paschedag J, Gilmore J, Kennedy N, Woolley TE, Heath R, Biskupovic Goulding R, Simpson V, Kiely E, Coll S, White M, Grijseels DM, Ouafik M, McLamore Q. Critically appraising the cass report: methodological flaws and unsupported claims. BMC Med Res Methodol. 2025 May 10;25(1):128. doi: 10.1186/s12874-025-02581-7. Erratum in: BMC Med Res Methodol. 2025 Dec 3;25(1):271. doi: 10.1186/s12874-025-02727-7. PMID: 40348955; PMCID: PMC12065279; Dowshen, Nadia & Baker, Kellan & Garofalo, Robert & Chen, Diane & Breland, David & Sequeira, Gina & Mehringer, Jamie & McNamara, Meredithe. (2025). A Critical Scientific Appraisal of the Health and Human Services Report on Pediatric Gender Dysphoria. Journal of Adolescent Health. 77. 10.1016/j.jadohealth.2025.06.002; An Evidence-Based Review of the Cass Review, https://law.yale.edu/sites/default/files/documents/integrity-project_cass-response.pdf  

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