CMS Issues Letters to Hospitals on Gender-Affirming Care Practices

On May 28, 2025, Centers for Medicare and Medicaid Services (CMS) Administrator Mehmet Oz sent a letter to select hospitals requesting information about the hospitals’ practices related to treatment for gender dysphoria in children. The letter also requests financial information related to pediatric gender-affirming care paid for “in whole or in part” by the federal government.

The Trump Administration’s focus on the treatment of gender dysphoria for children began shortly after the President’s inauguration.  Executive Order 14187, “Protecting Children From Chemical and Surgical Mutilation,” was released on January 28, 2025 and defined “children” to include individuals under 19 years of age.  The EO directed agencies to end grant funding for institutions that provide gender-affirming care for individuals under 19 and take steps to end coverage for gender-affirming care rendered to individuals under 19 under TRICARE and the Federal Employee Health Benefits program, among other directives. The funding provision of the EO has since been enjoined nationwide by the U.S. District Court for the District of Maryland, which is on appeal before the Fourth Circuit.  See PFLAG, Inc. v. Trump, No. CV 25-337-BAH, 2025 WL 685124 (D. Md. Mar. 4, 2025).

The May 28, 2025 letter comes weeks after the Department of Health and Human Services (HHS) issued a 409-page report sharply criticizing the gender-affirming care practices that have been widely adopted and accepted by medical societies and health care systems throughout much of the world. Citing the report, the May 28 letter to hospitals states CMS’s concerns with medical interventions related to gender-affirming care in children and requests that hospitals provide CMS within 30 days with their policies and procedures related to:

• Informed consent protocols for children with gender dysphoria;
• Changes to clinical practice guidelines and protocols the hospital plans to enact considering the report published by HHS; and
• Any adverse events related to gender-affirming care procedures, particularly for those who may wish to “detransition” at a later date.

The letter also requests financial data related to pediatric gender-affirming care (which the letter refers to as “sex trait modification,” consistent with the proposed rules issued by the Trump Administration in March that would prohibit coverage of gender-affirming care by Affordable Care Act plans) procedures performed at the institution and paid, in whole or in part, by the federal government, including:

• All billing codes used for “pediatric sex trat modifications (and that correspond with pediatric sex trait modification procedures not determined to be medically necessary)”;
• Facility- and provider-level revenue or utilization data generated directly or indirectly from these procedures since 2020;
• Facility- and provider-level operating and profit margins for each procedure type, including for directly or indirectly owned or affiliated providers; and
• Projected revenue forecasts for these service lines.

On the same day the CMS letter was sent requesting information from hospitals, HHS Secretary Robert F. Kennedy, Jr. sent a letter to health care providers, risk managers, and state medical boards urging them to read the HHS report and stating that the agency “expects” them to promptly update treatment protocols and training to conform with the report. Despite the stated expectation, to date, HHS has not issued any new rules or requirements to mandate updates to providers’ policies and procedures.

Health care providers and health systems that have been contacted by HHS should consult with counsel to assess their options and obligations, including legal requirements related to gender-affirming care that may vary by state.