Proposed federal rule changes put gender-affirming care in LA at even greater risk, advocates say

Advocates in Southern California say they’re worried that trans youth in the region will be without care, following Trump administration proposals essentially to ban gender-affirming hormones and surgeries to youth by cutting off all Medicare and Medicaid dollars to hospitals that support those patients.

NPR obtained a draft of the proposed rule change this fall. It cites an executive order from this January that characterized gender-affirming care for youth as “chemical and surgical mutilation,” a characterization that has been sharply denounced by medical and trans rights advocates.

“We have already seen Children’s Hospital Los Angeles and other health systems across the country pre-comply with executive orders that sought to accomplish exactly what these rules attempt to do,” LA LGBT Center CEO Joe Hollendoner said in a statement. “Thousands of transgender youth have already lost access to gender-affirming care, and unless these rules are stopped, it is believed that the vast majority of trans youth will be without care.”

Hospitals with a high percentage of patients on Medicaid and Medi-Cal, commonly known as safety net hospitals, would be the hardest hit if enacted.

Legal experts have told LAist these proposals are likely to be challenged and go through a lengthy legal process. Attorney General Rob Bonta already has said he intends to fight the proposed rules if they become final, a process that would take at least 60 days.

"If the Trump administration puts forth final rules similar to these proposals, we stand ready to use every tool in our toolbox to prevent them from ever going into effect," Bonta said in a statement.

Gov. Gavin Newsom also has come out against the proposals.

"California will always support access to health care for all people, including transgender Americans," Marissa Saldivar, a Newsom spokesperson, said in a statement provided to LAist. "Pulling federal support doesn’t make this care disappear – it just makes it harder to access, especially for low-income families and people with disabilities."

LAist also has reached out to local health care providers for comment.

The federal government previously threatened to cut off federal funding to Children’s Hospital Los Angeles earlier this year. The pressure led the hospital to close its clinic for trans youth care in July.

Months later, the Trump administration tried to force UCLA's hospital to stop offering gender-affirming care to people under 19 as part of a proposed settlement with the school. That ultimately was rejected, and a federal judge ordered the federal government to cease all “coercive and retaliatory conduct.”

If formally adopted, the rule changes would leave families with trans children with fewer options, including joining waitlists for providers who are not affected by the rule changes, seeking out care in other countries or waiting until individuals reach the age of 19 to transition medically.

Research shows that mental health outcomes are significantly better for trans youth who are able to access gender-affirming care as adolescents.