Virginia ends Medicaid coverage of gender-transition care for minors under federal rule

Virginia’s Medicaid program stopped covering gender-transition treatment for minors Tuesday as a federal rule took effect barring the use of federal Medicaid and Children’s Health Insurance Program dollars for such care. The rule does not prevent states from covering the services with state-only funds.

The state Department of Medical Assistance Services said in a bulletin dated Sept. 24 that, for services on or after Tuesday, it will no longer cover gender dysphoria services for Medicaid members younger than 18 or CHIP members younger than 19. Under the rule’s tapering provision, federal funding remains available for up to six months after Tuesday for youth already on hormone therapy, a group CMS has described that way. The bulletin refers to youth receiving “medications related to gender affirming care.” Mental health coverage is unchanged, the bulletin said.

The Centers for Medicare and Medicaid Services announced the rule Aug. 11. It covers puberty blockers, cross-sex hormones and surgical procedures, which the agency calls “sex-rejecting procedures.” CMS said the decision followed a Department of Health and Human Services review of national and international research that identified evidence gaps and safety concerns. CMS Administrator Dr. Mehmet Oz said children deserve protection, not “experimental interventions.”

The president wrote on Truth Social the same day, “We are not going to pay for our innocent children to undergo these barbaric surgeries and practices.” He also urged voters to remember the issue in the November midterm elections.

Democratic Gov. Abigail Spanberger told reporters Friday that the change reflects a Trump administration “that is changing access to health care,” not a choice by her administration to pull back funds. She said her office is “looking at every option available.” The Advocate reported that she has not announced a plan to use state money to maintain coverage.

Virginia is also among the states that sued the federal government over the rule Sept. 2 in federal court in Massachusetts. The states argue that Congress left Medicaid and CHIP coverage decisions to the states and that the rule exceeds federal authority. HHS declined to comment on the litigation, Courthouse News reported.

Major medical groups, including the American Academy of Pediatrics, have historically supported access to gender-affirming care for adolescents when medically appropriate and have opposed government restrictions on it.

Other states have responded differently. Illinois said in an Oct. 6 notice that it will use state-only funds to preserve coverage through the end of state fiscal year 2027.