Federal Register #2026-16508

HHS Final Rule: Prohibition of Federal Medicaid and CHIP Funding for Sex-Rejecting Procedures for Minors

This opportunity is a regulatory action by the Department of Health and Human Services (HHS), specifically the Centers for Medicare & Medicaid Services (CMS): - Final rule prohibits use of federal Medicaid and CHIP funds for sex-rejecting procedures for minors - Applies to children under 18 for Medicaid and under 19 for CHIP - Sex-rejecting procedures defined as pharmaceutical or surgical interventions to align a child's physical appearance with an asserted identity differing from biological sex - Excludes treatments for medically verifiable disorders of sexual development or other medical purposes - No products, equipment, or services are being procured; this is a policy change - No OEMs or vendors are involved - A 6-month tapering period is allowed for current recipients of cross-sex hormone therapy, with clinical discretion for safe discontinuation - States may continue to fund these procedures with state-only funds, but federal funding is prohibited - Estimated federal spending reduction of $138 million over 10 years - Rule clarifies definitions of sex, male, and female based on biological criteria

Description

This final rule from the Department of Health and Human Services and the Centers for Medicare & Medicaid Services prohibits federal funding for sex-rejecting procedures for minors under Medicaid and CHIP, effective October 13, 2026. The rule requires that State Medicaid plans will not make payments for sex-rejecting procedures for children under 18, and State CHIP plans will not make payments for such procedures for children under 19. Federal Medicaid and CHIP dollars cannot fund these procedures for individuals under these ages. There is a provision allowing ongoing claims for beneficiaries actively receiving cross-sex hormone therapy for up to 6 months from the effective date.

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