MONTGOMERY, Ala. — Alabama Attorney General Steve Marshall is leading a coalition of 24 state attorneys general urging federal health officials to permanently block Medicare, Medicaid and CHIP dollars from funding gender-affirming medical treatments for minors, a move critics say threatens access to essential care for transgender youth.
The letter, filed as public comments on two proposed Centers for Medicare & Medicaid Services rules, calls for an end to federal funding of puberty blockers, cross-sex hormones and surgeries for people under 18 — treatments medical groups like the American Academy of Pediatrics say are medically necessary and lifesaving for many transgender children.
Marshall’s office announced the filing Feb. 18, framing the treatments as “radical and dangerous sex-change procedures” and arguing they should never be subsidized by taxpayers. The coalition specifically cites evidence from litigation over Alabama’s ban on such care for minors, which the state has defended in federal court.
The push comes as CMS weighs restrictions on federal funding for these services amid a wave of state laws limiting access, with Marshall’s group of 24 Republican-led states pressing HHS Secretary Robert F. Kennedy Jr. to make any limits permanent. Opposing comments from health law advocates and civil rights groups filed the same week argue the proposed rules would harm vulnerable trans youth and violate federal protections.
In Alabama, where state law already bans gender-affirming care for those under 19, the federal effort could further limit options for families relying on Medicaid — the program covering about 1 in 4 children statewide — raising alarms among advocates who say it strips away care proven to reduce suicide risk and improve mental health outcomes for trans youth.