CMS Ends Federal Medicaid and CHIP Funding for Pharmaceutical and Surgical Gender-Affirming Care Interventions in Minors
August 31, 2026
The Top Line:As defined, gender-affirming voice and communication therapy would likely not be considered a “sex-rejecting procedure” under a federal funding rule recently finalized by CMS. However, clinicians should consult with their district or facility administration or legal counsel to determine billing and practice guidance for those serving Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries in this population.
On August 11, 2026, the Centers for Medicare & Medicaid Services (CMS) released a final rule that prohibits the use of federal Medicaid dollars on “sex-rejecting” procedures for individuals under 18 and prohibits the use of federal CHIP dollars for the same purpose for individuals under 19 years of age. This funding rule does not impact the legal ability to provide care.
CMS defines “sex-rejecting procedures” as follows:
“Sex-rejecting procedure is defined as any pharmaceutical or surgical intervention that attempts to align an individual's physical appearance or body with an asserted identity that differs from the individual's sex by either of the following:
- Intentionally disrupting or suppressing the normal development of natural biological functions, including primary or secondary sex-based traits; or
- Intentionally altering an individual's physical appearance or body, including amputating, minimizing or destroying primary or secondary sex-based traits such as the sexual and reproductive organs.
- For purposes of this definition, the term sex-rejecting procedure does not include procedures undertaken—
- To treat an individual with a medically verifiable disorder of sexual development; or
- For purposes other than attempting to align an individual's physical appearance or body with an asserted identity that differs from the individual's sex; or
- To treat complications, including any infection, injury, disease, or disorder that has been caused by or exacerbated by the performance of sex-rejecting procedure(s).”
Because gender-affirming voice and communication therapy is not a pharmaceutical or surgical intervention, it does not appear to fall within the rule’s definition of “sex-rejecting procedure.” However, state laws and Medicaid and CHIP policies may vary, so clinicians should consult their district or facility administration or legal counsel for billing and practice guidance.
Although the rule does not appear to directly restrict gender-affirming voice and communication therapy, it may affect broader care teams and care pathways for some patients, including care coordination and access to related services.
Federal financial participation will remain available for cross-sex hormone therapy for a tapering period of up to 6 months from October 13, 2026, for beneficiaries who were receiving such therapy as of October 13, 2026.
Questions?
Contact ASHA’s health care and education policy team at reimbursement@asha.org.
