NYHealth Comments on Proposed HHS Rules Affecting Access to Gender-Affirming Care

February 17, 2026

The Honorable Robert F. Kennedy, Jr.
Secretary
U.S. Department of Health and Human Services
200 Independence Avenue SW
Washington, DC 20201

Subject: Public Comment on Proposed HHS Rules Affecting Access to Gender-Affirming Care
Docket ID: CMS-3481-P and CMS-2451-P
Submitted via: regulations.gov

Re: Notice of Proposed Rulemaking: Medicare and Medicaid Programs; Hospital Condition of Participation: Prohibiting Sex-Rejecting Procedures for Children and Medicaid Program; Prohibition on Federal Medicaid and Children's Health Insurance Program Funding for Sex- Rejecting Procedures Furnished to Children

The New York Health Foundation (NYHealth) appreciates the opportunity to submit comments on the Department of Health and Human Services' (HHS) proposed rules affecting access to gender-affirming care.

NYHealth is a private foundation that works to improve the health of all New Yorkers and advance health equity. We offer these comments to underscore the importance of ensuring continued access to evidence-based, medically necessary care for all patients, including transgender and gender-diverse children.

The proposed rules would eliminate federal Medicaid funding for gender-affirming care services for minors in all provider venues and prohibit hospital participation in Medicaid and Medicare if they perform these services. Using government reimbursement to enforce compliance, the proposed rules erode provider autonomy, threaten the delivery of patient-centered care, and risk averse public health outcomes.

Gender-Affirming Care Is Evidence-Based, Patient-Centered, and Lifesaving

Leading medical organizations, including the American Academy of Pediatrics (AAP), recognize gender-affirming care as a medically necessary component of comprehensive health care for young patients.[1]^,[2] They emphasize that health care providers rely on established standards of care and clinical judgment and that treatment decisions should be made through shared decision-making among patients, families, and clinicians, guided by evidence and individual circumstances.[3] Restrictions that override clinical expertise with government policy directives threaten the delivery of high-quality, patient-centered care and interfere with patient-provider relationships.

Moreover, preserving access supports continuity of care, helping patients avoid preventable adverse outcomes and supporting long-term health. For many children, timely access to gender-affirming care is closely linked not only to physical health, but also to psychological safety, stability, and reduced risk of crisis. For example, disruptions in care may have significant consequences for mental health, particularly for youth already experiencing high rates of stress, stigma, and elevated suicide risk. A growing body of peer-reviewed research demonstrates that gender-affirming care is associated with improved mental health outcomes and reduced risk of depression, anxiety, self-harm, and suicidality among transgender and gender-diverse individuals, including during adolescence. In fact, recent longitudinal research published in the Journal of Adolescent Health found that access to gender-affirming medical care was associated with significantly lower rates of depression and suicidality among youth receiving care over time.[4]

Restricted Access Will Impact Public Health and Health System Performance

The proposed rules will limit access to medically necessary care, particularly for youth who already face significant barriers to services. Access restrictions could delay other treatment-including for children managing chronic diseases-increasing the risk that preventable conditions worsen and result in costlier care, including emergency room visits. Legal advocacy organizations have also cautioned that restrictive policies contribute to heightened distress, fear, and instability for transgender youth and their families, compounding existing mental health challenges and the risk of crises.[5]

Uncertainty and fear about eligibility and coverage may discourage families from seeking care altogether, even for unrelated health needs, undermining trust in health systems and providers. These impacts will reverberate across the broader public health and health system, as delayed access to preventive and outpatient care often results in more intensive interventions later on.

Recommendations

We respectfully urge HHS to:

1. Rescind the proposed rules that would restrict access to gender-affirming care by eliminating federal Medicaid funding for services for minors and placing hospital participation in Medicaid or Medicare at risk if they perform these services.
2. Affirm the role of clinical expertise and evidence-based standards of care in guiding medical decision-making for transgender and gender-diverse patients.
3. Ensure that federal health policy supports access to medically necessary care and promotes positive health outcomes for all individuals.

We appreciate the opportunity to provide comments. We encourage HHS to uphold policies that support medically-necessary care and safeguard patient-provider relationships. For questions regarding this submission, please contact Victoria Russo at [email protected] or (212) 584-7684.

Respectfully,

David Sandman, Ph.D.
President and CEO
New York Health Foundation

References

[1] Schweikart, Scott J., What's Wrong With Criminalizing Gender-Affirming Care of Transgender Adolescents?, AMA Journal of Ethics (June 2023). https://journalofethics.ama-assn.org/sites/joedb/files/2023-05/hlaw2-2306.pdf

[2] American Medical Association, Health Insurance Coverage for Gender-Affirming Care of Transgender Patients: Talking Points (2019). https://www.ama-assn.org/system/files/2019-03/transgender-coverage-talking-points.pdf

[3] American Academy of Pediatrics. AAP Opposes New HHS Rules Restricting Access to Care for Families. 2025.
https://www.aap.org/en/news-room/news-releases/aap/2025/aap-opposes-new-hhs-rules-restricting-access-to-care-for-families/

[4] Tordoff, D. M., et al. Mental Health Outcomes in Transgender and Nonbinary Youths Receiving Gender-Affirming Care. Journal of Adolescent Health, 2024.
https://www.jahonline.org/article/S1054-139X(24)00439-7/fulltext

[5] Lambda Legal. Lambda Legal Condemns Trump Administration's Latest Attack on Trans Youth. December 18, 2025.
https://lambdalegal.org/newsroom/us_20251218_ll-condemns-trump-admin-latest-attack-on-trans-youth/