Theo Wells-Spackman is a Report for America corps member who reports for VTDigger.
Updated 5:07 p.m.
Hospitals participating in Medicaid and Medicare would be prohibited from administering gender-affirming care to minors under one of several new proposed rules, Robert F. Kennedy Jr., secretary of the U.S. Department of Health and Human Services, said Thursday.
The announcement appears to clash with Vermont’s 2023 “shield laws,” which offer protections to providers and recipients of gender-affirming care, and establish that treatment as an essential part of full insurance coverage.
In a press conference Thursday morning, Kennedy said his department’s move was grounded in an executive order signed by President Donald Trump earlier this year. One new rule will seek to cut off federal Medicaid and Children’s Health Insurance Program funds for “sex-rejecting” practices for minors including hormone therapy and surgical procedures, among other treatments. Another proposes to withhold both Medicaid and Medicare money entirely from hospitals that provide those services.
“This is not medicine — it is malpractice,” Kennedy said of such care. “These procedures fail to meet professionally-recognized standards.”
Many of the country’s leading professional medical associations — including the American Medical Association and the American Academy of Pediatrics — are supportive of gender affirming care for minors.
The University of Vermont Medical Center’s Transgender Youth Program is the primary place in Vermont for young people to access gender-affirming care.
“We want our patients to know that as of today, there is no change in how we provide care,” a spokesperson for the hospital network said by email on Thursday. “We remain committed to ensuring the availability of evidence-based gender-affirming care … Research consistently shows that this care improves health and well-being, and decisions should remain between patients and their providers.”
Vermont Health Commissioner Rick Hildebrant stressed the state’s commitment to providing gender-affirming care Thursday.
“Access to gender affirming care is the law in Vermont,” Hildebrant said in an emailed statement. “We will continue to support providers and work to preserve access to care for vulnerable Vermont communities, regardless of any potential federal changes.”
Charity Clark, the state’s Attorney General, agreed, saying in a statement, “I want Vermonters to know that I will never stop fighting for you, including for access to gender-affirming care. I will use the full force of my office to defend our rights to control our own bodies, and that includes gender-affirming care for transgender youth.”
All of Vermont’s hospitals accept Medicaid patients. Indeed, each of the state’s hospitals relied on Medicare and Medicaid for more than two-thirds of inpatient care payments in 2022, according to an analysis by the American Hospital Association.
Mehmet Oz, who heads the Centers for Medicare and Medicaid Services, said the proposed rules would likely remain open for comment and deliberation for several months before they are finalized.
Advocates in Vermont expressed concern over Thursday’s developments.
“What the Trump administration knows is that it does not have the authority to change the law unilaterally, and so instead, it is focusing on funding,” said Monica Allard, a staff attorney at ACLU of Vermont, in an interview Thursday. “It’s trying to use that lever to essentially hold trans kids as hostages.”
If the rule is implemented in its current form, the state’s hospitals might be stuck between a rock and a hard place, she said, in balancing the treatment to which their patients are entitled against their institutional reliance on federal funds.
“Here in Vermont there are institutions that are very dependent on federal dollars that would face some real challenges,” Allard said. “It really calls for Vermont to develop some creative solutions.”
She also said the rule’s public comment period gave affected communities a crucial opportunity to have their concerns heard.
“It will be really important for Vermonters to lift up their voices,” Allard said.
Kennedy said he expects legal pushback to the new rules.
“The number of lawsuits with my name on it right now is almost beyond counting,” he said, adding that he was confident of eventual success in such litigation.
