Equality Arlington Opposes the U.S. Centers for Medicare and Medicaid Services’ Proposed Ban on Medicaid and CHIP Coverage of 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, “Prohibition on Federal Medicaid and Children’s Health Insurance Program Funding for Sex-Rejecting Procedures Furnished to 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.

There are over 800,000 low-income children enrolled in Medicaid and Family Access to Medical Insurance Security (FAMIS) programs in the commonwealth of Virginia.[1] This includes 27.4% of children in Arlington County.[2] Arlington children depend on these programs to access medically necessary health care services. Virginia is one of 26 states and the District of Columbia that requires its Medicaid/CHIP program to cover medically necessary gender affirming care for Medicaid and CHIP beneficiaries with gender dysphoria.[3] This requirement recognizes the overwhelming clinical evidence that supports access to medical services to treat gender dysphoria in youth.[4] Such services are provided by clinically trained providers, operating within clinical guidelines and nationally and internationally recognized standards of care.[5] However, CMS’s proposed rule tramples the ability of states to set standards and requirements for their Medicaid and CHIP programs and will harm children. Low-income transgender and non-binary youth residing in Arlington, Virginia deserve access to clinically appropriate care, including care and treatment necessary to treat gender dysphoria.

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.[6] 

Because the rule only prohibits coverage of certain identified services when provided for the treatment of gender dysphoria and allows coverage of those identical services for other diagnoses, the rule would require state Medicaid agencies to arbitrarily deny access to care simply because of a gender dysphoria diagnosis. Such a policy is in direct contradiction of federal Medicaid law and section 1557 of the Affordable Care Act, which prohibits discrimination in federal health programs based on gender identity.[7]

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] https://www.medicaid.gov/medicaid/national-medicaid-chip-program-information/medicaid-chip-enrollment-data/september-2025-medicaid-chip-enrollment-data-highlights

[2] Georgetown Center for Children and Families, Medicaid Coverage by County 2023, https://ccf.georgetown.edu/2025/02/06/medicaid-coverage-by-county-2023/

[3] Movement Advancement Project, https://www.lgbtmap.org/equality-maps/medicaid

[4] Poteat T, Davis AM, Gonzalez A. Standards of Care for Transgender and Gender Diverse People. JAMA.2023;329(21):1872–1874. doi:10.1001/jama.2023.8121

[5] Id.

[6] 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

[7] See legal analysis conducted by Epstein, Becker, Green, CMS Seeks to Ban Hospitals from Providing Gender-Affirming Care to Minor, December 30, 2025, https://www.ebglaw.com/insights/publications/cms-seeks-to-ban-hospitals-from-providing-gender-affirming-care-to-minors

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