The Brief

The Trump administration is abandoning its most aggressive attempt to end gender-affirming care for youth nationally, according to an official document obtained by NPR.

The document shows that the Department of Health and Human Services will not be finalizing a proposed rule that would have blocked all Medicaid and Medicare funding for hospitals that provide pediatric gender-affirming care.

The Centers for Medicare and Medicaid Services told NPR in a statement: "CMS does not comment on future rulemaking or speculate on potential actions. The Trump Administration rejects ideologically driven surgical interventions on vulnerable children."

(Surgery is very rare among transgender people under age 18, and the rule applied to all gender-affirming care, which is mainly therapy and medications for children.)

A "victory" for trans rights, but not a "retreat" by HHS

The fact that the Trump administration is backing off from this action is "a victory for people who are defending the rights and interests of trans people," says Sam Bagenstos, a professor at Michigan Law who served as general counsel at HHS under the Biden administration. "But I don't think it indicates a more general retreat from the aggressive posture of the Trump administration."

Bagenstos notes that this type of leverage — a "conditions of participation" rule for the Medicare and Medicaid program — has historically been used by HHS to compel states and hospitals to meet basic health and safety standards. Things like "making sure that you have stockpiles of certain kinds of equipment, making sure that you have certain kinds of emergency protocols, making sure that you have certain staffing ratios," he explains.

The proposed rule was unprecedented, Bagenstos says, because it instead would have prohibited certain kinds of treatments for a certain population. He says it seemed unlawful in a variety of ways. For one, "it violates the Medicare Act, which says that Medicare and Medicaid can't be used to control the practice of medicine within the state — states get to regulate the practice of medicine," Bagenstos says.

Medical groups opposed the change

Normally, HHS would propose a rule, accept public comment for 60 days, and then finalize the rule so that it could take effect. In this case, after proposing the rule in December and receiving more than 30,000 comments, the administration is abandoning the rule. At least in the next year, it will not be finalized and will not take effect.

The American Medical Association and the Children's Hospital Association both submitted comments urging the agency to rescind or withdraw the proposed rule. Major U.S. medical groups say that puberty blockers and sex hormones are safe and can be effective for transgender young people.

Even so, gender-affirming care for youth is banned in 27 states after a flurry of laws passed over the last several years. In the remaining 23 states, many hospital clinics that offer gender-affirming care have continued to operate, while others have shuttered in the past year citing pressure from the Trump administration.

That pressure has come in the form of this proposed rule, another rule that would bar federal Medicaid reimbursement for transgender pediatric patients, and a declaration from Health Secretary Robert F. Kennedy Jr. that aimed to redefine the standard of care. (Interestingly, the press release issued when those actions were unveiled in December is now missing from the HHS website, as is the Kennedy declaration document.)

The Medicaid rule is currently in the final stage of review and appears to be on track to take effect in the coming weeks. A coalition of Democratic-led states sued over the so-called Kennedy declaration and succeeded in blocking it in federal court in Oregon. The Trump administration has not appealed that decision so far.

Protesters who are against gender-affirming care for young people gathered outside Boston Children's Hospital in September 2022.

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Carlin Stiehl for The Boston Globe

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At the same time, the Department of Justice has issued administrative and criminal subpoenas to hospitals seeking full personal medical files for transgender youth and employment files for their medical providers, although many of those attempts have been blocked in court so far. The Trump administration has also reached settlements with hospitals in Texas and Ohio that involved establishing "detransition" clinics.

And last month, when the Supreme Court allowed states to bar young transgender girls from sports, the White House issued a press release saying that the decision "Bolsters President Trump's Push to Eliminate Transgender Insanity." The release listed actions targeting transgender people across the federal government, from passport markers to military service to research funding.

Will hospitals that ended care for trans youth restart it?

While the Trump administration does not appear to be backing down from anti-transgender actions broadly, its decision not to finalize its most aggressive healthcare rule is significant, says Katie Keith, director of the Health Policy and the Law Initiative at Georgetown University who also worked in the Biden administration. Those other efforts are not nearly as durable as a finalized rule that takes effect, she notes.

The decision of the Trump administration not to finalize this rule "should give hospitals more confidence to either resume or continue offering the care," she says. Because the rule was never in effect, "I would argue that they should have been doing this all along anyway."

Kellan Baker agrees. He's a senior adviser for health policy at the Movement Advancement Project think tank, which focuses on LGBTQ issues. "This administration may have checked itself in one of the most extreme expressions of its agenda and I think people should take solace in that," he says. "But at the same time, this administration is continuing to show that its ultimate goal is eliminating healthcare for trans people and that it is apparently prepared to use almost any means necessary to do so."

The Medicare and Medicaid rule could theoretically be revived at some point, since it has not been formally withdrawn. An entry in the Trump administration's recent unified agenda sets a final action date for the proposed rule as December 2028, just before President Trump leaves office.

Copyright 2026 NPR

Gov. Gavin Newsom has signed a new law that expands the state's mobile ID program to 60% of licensed drivers, his office announced Monday.

For the last few years, participating residents have been able to use the state-issued mobile app and store their IDs in certain phone wallets as part of a pilot program.

Where you can use it

The program works for driver's licenses and state IDs.

The mobile version is mainly valid at airport security, but use is expected to expand in the future.

TSA accepts the California DMV Wallet App, as well as Apple, Google or Samsung wallets. A small number of stores accept them for age-restricted purchases.

One big caveat: Mobile IDs are not accepted by law enforcement or most state government agencies.

That means you should still keep your physical ID or license with you, especially if you're driving. You can find a full list of accepted places on the DMV's website.

How you can apply

Access to the program was previously capped to 4.2 million drivers — now that's quadrupled to over 16 million.

You can join the pilot by downloading the CA DMV Wallet app from your phone's app store and logging into your MyDMV account.

You'll need to provide your driver's license or ID card information. The app will prompt you to scan your card, and you'll have to refresh the mobile ID every 30 days.

More than 3.5 million Californians have joined so far.

At the Sea Castle apartments, just steps from the beach in Santa Monica, a small one-bedroom with an ocean view starts at $2,900 per month. But some tenants pay only about 30% of their income and use Section 8 housing vouchers or other government subsidies to cover the rest.

Moving in was life-changing for Lorenna Taylor, 55.

“It took me a week to get up my nerve to come here and apply,” she said, wearing bike shorts and an animal-rights T-shirt outside the eight-story beachfront building that’s a short walk from Santa Monica Pier.

Taylor moved here about a year ago from a nonprofit-run affordable apartment building in the city that was “nasty” and, she said, management “treated us badly.” But she found a warm welcome at the Sea Castle. Now, she said, “I’m able to live the life I want to live. I’m handling stress better.”

The Housing Choice Voucher program — also known as Section 8 — helps 2.4 million households nationwide who can’t afford market rents to stay housed. It is supposed to give participants a chance to live where they choose, including in communities like Santa Monica, one of the Los Angeles area’s most desirable places to live not only for its sea air and ocean views, but because of the city’s high-achieving schools and plentiful parks and libraries.

But in Los Angeles County, relatively few voucher holders enjoy those amenities. More than two-thirds of Los Angeles County voucher holders live in areas the state considers “low resource,” according to a Capital & Main analysis of data from the U.S. Department of Housing and Urban Development, California state housing agencies and the U.S. Census Bureau. Six of the 20 L.A. County census tracts with the most voucher holders also rank among the county’s highest in rates of poverty and racial segregation.

Santa Monica is an outlier in the county, the analysis showed. All of the census tracts in the city, which is home to more than 1,500 voucher holders, are considered “high resource.” Higher resource tracts have higher home values, households with higher incomes and better academic outcomes compared to the rest of the state.

In response to Capital & Main’s findings, California Civil Rights Department spokesperson Rishi Khalsa said his department, which enforces anti-housing discrimination law, “is always interested in identifying any additional potential pattern in discrimination.” Such discrimination “can certainly be one of many factors that might contribute to a higher concentration of voucher holders in low opportunity neighborhoods.”

Marcie Vega, director of Assisted Housing Programs for the Housing Authority of the City of Los Angeles, noted that “even with a voucher, low-income renters are competing for a very limited number of available homes.”

Discrimination is also a factor despite laws in California, the District of Columbia and 23 other states that make it illegal for landlords to reject tenants because they rely on housing assistance. A recent Capital & Main investigation found that some of the county’s largest landlords avoid Section 8 renters.

Responding to suspected discrimination

Sea Castle, where low-income tenants live side by side with affluent neighbors, is an example of the program working as intended.

One reason the Section 8 program works well in Santa Monica may be the city’s immediate response to suspected discrimination. Romy Ganschow, a chief deputy city attorney who oversees the program, said that an attorney contacts the landlord — often within a day of receiving a discrimination report — to explain the law and the city’s determination to enforce it.

“By the time the tenant files a lawsuit or gets the authorities involved the unit’s going to be given away to somebody else,” Ganschow said.

Indeed, the state Civil Rights Department, which takes most such complaints, can take more than a year to resolve them. The city’s rapid response turned some 40 refusals to rent into offers to lease between 2015 and 2024, Ganschow said.

Santa Monica’s enforcement system is “extremely unique,” said Michelle Uzeta, executive director of the Berkeley-based Disability Rights Education and Defense Fund, which advocates for fair housing.

“There’s no other city that does anything like that in California,” Uzeta said. In 2023, she requested public records from 16 cities, including Los Angeles, that had passed local laws prohibiting discrimination against tenants with housing assistance. She asked them to provide data on enforcement efforts and describe them.

“Only one of the municipalities contacted — the City of Santa Monica — had taken any affirmative enforcement action to enforce the source of income protections in their local ordinances,” Uzeta said in an email.

“For people to be able to use their Section 8 vouchers is a major solution to our homelessness crisis,” Ganschow added, noting that housing discrimination is “rampant in areas that don’t have this level of enforcement.”

Sea Castle resident Tom Lang and his disabled dog, Karma, live at the Sea Castle in Santa Monica.

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Jeremy Lindenfeld

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Capital & Main

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Getting into Sea Castle was that kind of solution for 56-year-old Tom Lang, who was homeless and living on the beach 16 years ago. He had a Section 8 voucher but he thought his chance of moving in was almost nil.

“I walked in just to stink up the lobby,” he joked.

At that time, Lang said he had just one more day to find an apartment before his Section 8 voucher expired. Voucher holders usually have between two and six months, or they lose their eligibility — and Lang’s was nearly up.

“You got a Section 8 opening for a bum like me?” he recalled asking a building manager. His timing was right, and the manager said yes.

Lang doesn’t owe his luck to city enforcement; Santa Monica approved its law prohibiting discrimination against housing voucher holders five years after he moved in. But he is pleased with the apartment he shares with Karma, his 15-year-old poodle mix who uses only her front legs and a wheeled contraption to get around. As Lang sat outside the building, several of his neighbors waved or stopped to chat.

“They love me,” he said. “I’m not crazy, and everybody likes my dog.”

Sea Castle tenant Colin Chen was heading home on a recent weekday morning with a canvas Trader Joe’s bag full of groceries slung over his shoulder. He said he had learned from casual conversation in the building that some of his neighbors pay rent with government subsidies.

“We all just commingle,” he said.

Not everyone is so accepting. One tenant grumbled about neighbors who don’t work.

Enforcing housing laws in California

In California, fair housing laws are mostly enforced at the state level by the Civil Rights Department. But its resources are stretched thin. One attorney and three investigators enforce laws that bar discrimination against people who use government housing assistance. Resolving complaints can take a year or more. Spokesperson Rishi Khalsa said the department has an online portal where members of the public can report discriminatory ads, like those that say “No Section 8.” The department also holds regular educational webinars for landlords and tenants on a range of civil rights issues.

“When people do report, our department reviews it and sends a notice to the entity to remind them of their legal obligations,” Khalsa wrote in an email.

Local fair housing enforcement is likely one reason that affluent downtown Santa Monica, where the Sea Castle is located, ranks 12th among L.A. County census tracts with the highest voucher holder populations in the county. Census tracts are small geographic areas of 1,200 to 8,000 people that researchers use to study demographic trends and socioeconomic disparities. Of the 20 L.A. County tracts with the most voucher holders, the tract that includes downtown Santa Monica is the only one that state housing officials categorize as “high-resource,” based on measures such as income, employment and high school graduation rates, Capital & Main’s analysis found.

Wesley Wellman, a founder of ACTION Apartment Association Inc., a Santa Monica landlord group that has often been at odds with the city’s pro-renter policies, praised the city’s fair housing enforcement as “a constructive approach to attempt to resolve discrimination complaints as soon as they arise rather than just defaulting to litigation.”

In the city of Los Angeles, where affordable housing is also a top issue, Ivor Pine, a city attorney’s office spokesperson, said in an email that the office “takes the issue of fair housing and the prevention of housing discrimination for all tenants — including those relying on government subsidies — very seriously.”

Pine didn’t answer Capital & Main’s question about whether the city attorney’s office had considered a more active approach to enforcement, like Santa Monica’s. He noted that the office had sent cease-and-desist letters to landlords whose advertisements said they don’t accept Section 8 tenants, but didn’t respond to follow-up questions about how many such letters were sent, when they were sent and what the results were.

Finding a place to live

In fact, most Section 8 tenants who want to live in more affluent areas of L.A. County lack the backing that Santa Monica tenants have.

When Jennifer St. Jude planned to move from the remote high desert city of Lancaster — 80 miles north of downtown LA — to a neighborhood where she and her two adult daughters could more easily access services for their disabilities, she said it was almost impossible to find a landlord who would accept her Section 8 voucher. The search was even harder, she said, because many landlords charged higher rents than the Los Angeles County Development Authority, the county’s housing authority, was willing to pay.

“You can’t get a house or an apartment or anything, anywhere outside of low income areas,” said St. Jude, who is a graduate student in social work at the University of Southern California. “It was like, nope, nope, nope, nope.”

Just one in five voucher holders in L.A. County live in a census tract that the state ranks as either “high” or “highest resource.”

“Living in a high resource, low poverty neighborhood is really good — especially for kids for long-term life outcomes,” said Martha Galvez, executive director of the Housing Solutions Lab at New York University’s Furman Center, whose research backs up her view.

The Housing Authority of the City of Los Angeles is part of a national Community Choice Demonstration project to help voucher holders move to more affluent areas. The few hundred L.A. families who participate are given a coach, move-in expenses and housing search assistance. The Los Angeles housing authority is also among several that offer higher rent ceilings in more expensive ZIP codes to give voucher holders a better shot at living in those areas. Last year, however, the rent ceilings were lowered because of a budget shortfall, and the agency stopped issuing new vouchers to the more than 24,000 people on its already years-long waiting list. In June, HACLA spokesperson Courtney Harris told Capital & Main that the budget picture has improved, but wouldn’t comment on whether rent payment limits would increase or whether the agency would resume issuing new vouchers.

Funding is also uncertain as Congress considers next year’s Department of Housing and Urban Development budget. The National Association of Housing and Redevelopment Officials has raised concerns that House budget proposals would not cover rising Section 8 program costs.

In mid-2024, after an 18-month search, Jennifer St. Jude finally found a house in Castaic, a northern L.A. County suburb the state considers “high resource” based on factors like home values and its residents’ incomes and educational attainment. She and her daughters finally began receiving the support services they needed.

“It was grueling to get to this place, and my heart breaks for all the people that will never be able to fight that battle and get a house,” she said.

Back in Santa Monica, Lorenna Taylor said that her new apartment is “amazing because when you’ve been beat down so long, it’s hard to accept that this can be possible.” Gesturing toward the ocean, she said, “I come out here and I can just let it all go.”

Derek Thomas of Thomas Data Consulting supported the analysis and created the data visualizations for this story.

Copyright Capital & Main 2026