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Where the Bans Stand
Twenty-seven states now restrict or ban gender-affirming medical care for transgender minors. That includes puberty blockers, hormone therapy, and surgery. Most of these laws passed between 2023 and 2025.
The Supreme Court made things worse in June 2025. In United States v. Skrmetti, the Court ruled 6-3 that Tennessee’s ban on gender-affirming care for minors does not violate the Equal Protection Clause. The majority held that the law classifies by age and medical use, not by sex or transgender status, and applied the lowest level of legal scrutiny. Justices Sotomayor, Jackson, and Kagan dissented.
The ruling did not ban care nationally. But it removed the main constitutional argument against state bans, leaving 25 existing laws intact and clearing the path for more.
The Federal Push
The Trump administration is not waiting for states. On December 18, 2025, CMS proposed two rules that would bar any Medicare- or Medicaid-certified hospital from providing gender-affirming care to anyone under 18. The rules use the term “sex-rejecting procedures” and cover puberty blockers, hormones, and surgeries with narrow exceptions.
A second proposed rule would prohibit state Medicaid and CHIP plans from covering the same treatments. If finalized, that rule takes effect October 1, 2026. The public comment period closed February 17, 2026. Legal challenges are expected.
This is not just about hospitals that currently provide the care. It is about threatening any hospital’s Medicare certification — its financial lifeline — if it does not comply.
Courts Are Still Pushing Back
Not every state ban is surviving legal challenge.
| State | Status |
|---|---|
| Kansas | Judge blocked SB 63 in May 2026, finding it likely violates state constitutional protections for personal autonomy and parental rights |
| Montana | Ban permanently enjoined by court order |
| Arkansas | Ban permanently enjoined by court order |
On May 16, 2026, Kansas Judge Carl Folsom wrote a 117-page ruling and questioned the credibility of most of the state’s expert witnesses. Kansas Attorney General Kris Kobach called the ruling “judicial activism” and plans to appeal.
These state-level fights are where the legal action is now. Read more on our LGBTQ Rights hub.
What You Can Do
- Check the KFF policy tracker to see where your state stands, then call your state legislators to oppose any pending ban or to support shield laws that protect families.
- If the CMS rule has not been finalized, contact your U.S. senators and ask them to oppose the proposed hospital and Medicaid rules. Name the rule numbers: CMS-2025-1823 (hospital conditions) and CMS-2025-23464 (Medicaid funding).
- Support organizations providing direct legal defense for families, including the ACLU’s trans rights project and Lambda Legal.
Primary Sources
- KFF: Youth access to gender-affirming care policy tracker
- Supreme Court opinion in United States v. Skrmetti (June 2025)
- CMS proposed rule: Hospital conditions of participation (December 2025)
- CMS proposed rule: Medicaid/CHIP funding prohibition (December 2025)
- Kansas judge blocks gender-affirming care ban (May 2026)
- ACLU of Kansas on SB 63 ruling