Attorney General Charity Clark todayjoined a coalition of 20 attorneys general in submitting comment letters opposing two proposed rules by the United States Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) that would prevent hospitals and medical providers from providing, and youth from receiving, essential transgender healthcare by threatening to withhold funds through the Medicare and Medicaid programs.

In December 2025, CMS proposed two rules that, if implemented, would bar hospitals from providing medically necessary transgender healthcare to youth by withholding Medicaid and Medicare funds to any hospitals that continue to provide such care and prohibiting state Medicaid and Children's Health Insurance Program (CHIP) plans from using federal funding for medically necessary transgender youth healthcare.

The proposed Medicaid reimbursement rule would deprive states of their congressionally authorized role as Medicaid administrators and the proposed hospital conditions of participation rule would strip public and private hospitals in Vermont of vital Medicare and Medicaid hospital funding for all healthcare, solely because a hospital offers some individuals transgender youth healthcare. Attorney General Clarkand the coalition explain CMS and the federal government lack the power to deprive states of their longstanding duty to regulate the practice of medicine in ways that ensure access to medically necessary healthcare for the safety and well-being of their residents.

Attorney General Clark and the coalition assert in their comment lettersthat the proposed rules intrude on the states' rights to regulate medicine within their borders, violate the Spending Clause and Equal Protection Clause, and contradict various statutes including the Social Security Act, the Affordable Care Act, the Administrative Procedure Act, and vital nondiscrimination laws. The proposed rules further reflect HHS's decision to discriminate against transgender youth despite contrary medical and scientific evidence, as shown by the agency's failure to faithfully engage in the rulemaking process, including its lack of required regulatory impact and flexibility analyses.

For example, the letters explain that CMS attempts to support the rules by referencing its own commissioned HHS report, without addressing medical and scientific evidence unfavorable to its position. However, the HHS report has been discredited as methodologically flawed because it was anonymously published without peer review and issued at the direction of the president to support his goal of ending transgender health care. Additionally, the proposed rules will bear significant costs to transgender youth, their families and their healthcare providers, which HHS does not account for.

Joining Attorney General Clarkin sending both these letters are the attorneys general of Arizona, California, Colorado, Connecticut, Delaware, the District of Columbia, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New York, Oregon, Rhode Island, Washington and Wisconsin.

The letters are available on our website.

CONTACT: Amelia Vath, Senior Advisor to the Attorney General, 802-828-3171