The memo appears intended to create a chilling effect in hospitals and other healthcare settings that provide gender-affirming care, while spreading misinformation about its medical appropriateness. Referring to medically necessary, life-saving care for transgender youth as “chemical and surgical mutilation” is both inaccurate and deeply offensive to patients, families, and providers. Moreover, the memo’s implied threat to withhold insurance reimbursement and grant funding from hospitals and health systems offering gender-affirming care to individuals under 19 could have serious mental and physical health consequences for transgender children and adolescents, potentially leaving them without access to comprehensive, evidence-based care in their local communities.
A written policy statement issued by a government agency or executive official that provides guidance, clarification, or direction on implementing laws or policies. Memos do not have the force of law but can influence policy interpretation and enforcement.
Who It Impacts: Federal agencies, policymakers, and sometimes regulated industries. Memos can shape how agencies enforce laws, impacting businesses, healthcare providers, and other stakeholders.
Who Is Not Impacted: Memos do not create binding legal requirements for the general public, though they can influence enforcement priorities that indirectly affect individuals and organizations.
Summary
CMS issued a "Quality and Safety Special Alert Memo" to hospitals and other providers, characterizing medically appropriate gender-affirming care for children and adolescents — which the memo refers to as “chemical and surgical mutilation” — as dangerous and lacking scientific support. While the memo does not mandate any immediate action, it signals that CMS may consider future measures to restrict access to gender-affirming care. Additionally, the memo includes misrepresentations of data on transgender identity and references an openly anti-transgender organization actively working to limit access to this type of care.
Impact Analysis
Legal Challenges
PFLAG, Inc. v. Trump;
Take Institutional Action
Health systems and providers should continue delivering essential, evidence-based, and culturally competent care to all patients, regardless of gender identity or sexual orientation.
Healthcare institutions and providers should also understand the laws that govern their care, understand the ecosystem of advocates in their localities, and take action together. Understanding laws include those that govern practice in their state, such as whether they have ""shield laws"" in place (link to: https://www.lgbtmap.org/equality-maps/healthcare/trans_shield_laws), the position of their state attorney general and anti-discrimination laws (link to https://www.kff.org/other/dashboard/gender-affirming-care-policy-tracker/)
Taking action is best done in concert with local advocates, and can include using the levers of power available to you as a health professional to join with their colleagues to advocate for the rights of transgender people, which can happen on the individual level (link to: https://transequality.org/resources/how-testify-trans-rights) or the institutional level (link to: https://transgenderlawcenter.org/resources/health/orgguide/)"
Associated or Derivative Policies
Policy Prior to 2025
Additional Resources
AAP speaks out against HHS report on gender dysphoria, infringement on physician-patient relationship (https://publications.aap.org/aapnews/news/32145/AAP-speaks-out-against-HHS-report-on-gender?_gl=1*p8bg9o*_ga*MTc2ODA5NTg2Mi4xNzQ3NDA1MTA1*_ga_FD9D3XZVQQ*czE3NDc0MDUxMDUkbzEkZzEkdDE3NDc0MDUyMjckajAkbDAkaDA.*_gcl_au*MTI1NDE3MTA5OC4xNzQ3NDA1MTI3*_ga_GMZCQS1K47*czE3NDc0MDUxMjkkbzEkZzEkdDE3NDc0MDUyMjckajAkbDAkaDA.)
Medicaid Coverage for Gender Affirming Care (https://williamsinstitute.law.ucla.edu/wp-content/uploads/Medicaid-Gender-Care-Dec-2022.pdf)
