By Shannon Minter, Legal Director at the National Center for LGBTQ Rights (NCLR) and Jennifer Levi, Senior Director of Transgender and Queer Rights at GLAD Law

On February 17, 2026, NCLR joined GLAD Law and COLAGE in filing formal comments opposing a proposed federal rule that would devastate health care access for transgender young people across the country. Here’s what you need to know – and why this matters.

What is this proposed rule?

In December 2025, the Centers for Medicare and Medicaid Services (CMS) proposed a rule that would strip Medicare and Medicaid funding from any hospital that provides medically necessary transgender health care to minors. And we don’t just mean cutting funding for those specific services – we mean all Medicare and Medicaid funding for the entire hospital.

That’s not a typo. Under this rule, if a hospital provides evidence-based, doctor-recommended care to even one transgender teenager, it risks losing every dollar of federal health care funding it receives. For every patient. Given that the vast majority of hospitals depend on Medicare and Medicaid for often more than half of their revenue, this amounts to a threat that no hospital can afford to ignore.

To make matters worse, the rule applies “regardless of payor” – meaning a hospital couldn’t even provide this care to a privately insured patient using private funds without jeopardizing its entire federal funding stream.

This isn’t about safety. It’s about targeting transgender kids.

CMS is framing this as a routine hospital safety regulation. It’s not. For over 60 years, hospital participation standards have addressed things like staffing ratios, medical records, and fire safety – the nuts and bolts of running a hospital safely. Never before has CMS used these standards to impose a nationwide ban on a category of medical treatment for a specific group of patients.

The timing tells the real story. On the very same day CMS released this rule, it also released a companion rule stripping Medicaid matching funds state’s receive for the same care. The Department of Health and Human Services issued a press release trumpeting both actions as a coordinated effort. Internal cross-references between the two rules even acknowledge that each one’s impact depends on the other – a candid admission that they were designed to work together to eliminate access to care for transgender adolescents from every possible angle.

Meanwhile, the Department of Justice has been issuing subpoenas to healthcare providers, demanding the private medical records of transgender youth. Every federal court that has reviewed these subpoenas has rejected them, with multiple judges finding they were issued to pressure providers into stopping care rather than to investigate any actual wrongdoing. One court noted that the government’s demand for deeply private patient information carried “more than a whiff of ill-intent.”

The rule’s own numbers reveal the harm.

Even CMS’s own impact analysis – which dramatically understates the real costs – acknowledges that this rule would force thousands of families to disrupt their children’s existing medical care, costing at least $7 million in the first year as families scramble to find new providers. CMS itself admits this is probably an undercount.

More troublingly, CMS estimates that thousands of young people currently receiving care at hospitals simply wouldn’t be able to get it anywhere else because no alternative providers exist in their area. Rather than treating this as the devastating health care crisis it is, the agency counts it as a cost savings. That’s right — the government is framing the denial of medical care to vulnerable young people as a budgetary win, without any attempt to account for what happens to those kids when their treatment is abruptly cut off.

The medical community has been clear: this care is well-established and essential.

The proposed rule leans heavily on a single report commissioned by HHS under an executive order specifically aimed at ending transgender health care for minors. Leading medical organizations immediately challenged that report. The American Academy of Pediatrics, the American Medical Association, the American Psychological Association, and numerous other professional groups have made clear that the report misrepresents the medical evidence, cites their own policies inaccurately, and prioritizes political goals over science.

The established standard of care involves careful, individualized assessment by multidisciplinary teams. Medical interventions are reserved for a subset of adolescents with persistent gender dysphoria, after thorough evaluation and with ongoing mental health support. This is cautious, evidence-informed medicine – not the reckless caricature the proposed rule describes.

Notably, the HHS report promotes psychotherapy-only approaches while acknowledging there’s no evidence that psychotherapy alone resolves gender dysphoria. It even platforms “gender exploratory therapy,” which experts have identified as a form of conversion therapy – a practice that is prohibited in nearly half the states and the District of Columbia and universally rejected as ineffective and harmful by every major medical and mental health organization.

The legal problems are serious.

Our comment lays out several reasons this rule cannot stand as a matter of law. Federal law explicitly prohibits CMS from exercising “supervision or control over the practice of medicine.” The regulation of medical practice has always been a state responsibility. Yet this rule would impose a one-size-fits-all federal ban, overriding the judgment of state legislatures, medical boards, and treating physicians alike – including in the 17 states and D.C. that have specifically enacted laws to protect access to this care.

The rule also directly conflicts with how Medicaid is supposed to work. States have built their pediatric care delivery systems around hospital-based programs. Yanking those hospitals out of the system would force states to rebuild their networks on short notice, collapse access for Medicaid patients far beyond transgender youth, and violate patients’ legal right to choose their own providers.

And the “choice” the rule offers hospitals is no choice at all. When virtually every hospital in the country depends on federal funding to survive, threatening to take all of it away unless hospitals stop providing one kind of lawful medical care isn’t a condition – it’s coercion.

What we’re asking for – and what you can do.

We are calling on CMS to withdraw this proposed rule entirely. It is legally indefensible, medically unsound, and designed not to protect anyone’s health or safety but to target transgender young people and their families.

You can help by sharing this post, talking to people in your life about what’s at stake, and making sure your community understands what this rule would actually do. When people hear that the federal government is threatening to defund entire hospitals to prevent doctors from providing medically necessary care to a small number of young people, they understand how extreme this is. Spread the word.

Transgender young people deserve the same access to evidence-based medical care as every other young person in this country. NCLR and GLAD Law will continue fighting to make sure they get it.

NCLR filed this comment jointly with GLAD Law and COLAGE. Read the full legal comment.