Trump Administration Moves to Restrict Gender-Affirming Care for Federal Employees and Families

In a sweeping change to federal health policy, the Trump administration announced in August 2025 that it will remove gender-affirming care—including hormone therapies and surgeries—from the list of services covered under the Federal Employees Health Benefits Program, effective with the 2026 plan year. The FEHB Program insures more than 8 million federal employees, retirees, and their dependents, making this one of the largest single health care policy changes affecting transgender and gender-diverse people in the United States in recent years .

Under the new policy, mental health counseling for gender dysphoria will remain covered, and there will be a case-by-case exceptions process for individuals already receiving treatment. However, advocacy groups and medical experts warn that these carveouts are neither uniform nor reliable, threatening continuity of care and creating new barriers for transgender people who need medically necessary interventions .

The FEHB change is part of a larger pattern of federal policy shifts under President Trump since January 2025, aimed at rolling back protections for LGBTQ+ communities. Executive orders issued this year have:

- Canceled existing policies that supported LGBTQ+ rights in federal health programs.
- Directed agencies to cease recognition of gender identity in health services.
- Cut funding for programs serving LGBTQ+ populations.
- Ended diversity, equity, and inclusion programs in federal health agencies.
- Conditioned federal research and education grants on recipients not providing gender-affirming care to youth .

One key executive order, signed January 28, 2025, specifically directs all federal agencies to rescind or amend policies that reference the World Professional Association for Transgender Health guidelines, which are the internationally recognized standards of care for transgender people. It further instructs agencies to end federal support for gender-affirming care for individuals under 19, including through Medicare, Medicaid, and federal grants, and to enforce existing and new state laws restricting such care .

Transgender people and their families who rely on FEHB for essential health services now face the prospect of losing coverage for medically necessary treatments. Organizations such as Lambda Legal have condemned the move as unlawful and a violation of sex discrimination protections under federal law . The loss of insurance coverage is likely to force many to pay out of pocket—often prohibitively expensive—or forgo care entirely, leading to adverse mental and physical health outcomes.

A June 2025 report by Human Rights Watch documented how similar bans and restrictions at the state level had already caused serious harm, including deteriorating mental health and abrupt discontinuation of treatment for transgender youth . The expansion of such restrictions to a federal program of FEHB’s scale marks a significant escalation, with implications for workplace equality, recruitment, and retention in the federal workforce.

Health care providers and hospitals are also affected. The Department of Justice subpoenaed more than 20 hospitals that had young gender-affirming care patients, leading some clinics to cease or radically reduce these services, particularly for minors . The chilling effect has further limited already scarce access to affirming care providers.

The Trump administration’s orders signal a reinterpretation of Section 1557 of the Affordable Care Act, which previously provided explicit protections against discrimination on the basis of sexual orientation and gender identity in health care . The new interpretation would remove these protections, leaving LGBTQ+ people more vulnerable to discrimination in health settings.

Additionally, a letter from the Department of Health and Human Services in February 2025 clarified that Ryan White HIV/AIDS Program funds, which had been used under the previous administration to support gender-affirming care for transgender people with HIV, can no longer be used for these services. This change may undermine efforts to engage and retain transgender people in HIV care, with potential public health consequences .

Civil rights and LGBTQ+ advocacy organizations have responded with outrage and have announced plans to challenge the new rules in court. Lambda Legal, Human Rights Campaign, and other groups argue that these exclusions violate both statutory and constitutional protections, including Title VII and Section 1557, as well as the equal protection clause of the Fourteenth Amendment .

In a joint statement, several organizations declared: “Stripping coverage for gender-affirming care from the FEHB program is discriminatory, unsupported by medical evidence, and contrary to the principles of equal access to health care” .

For many in the transgender and queer communities, the policy changes represent not only a loss of vital health care, but also a fundamental denial of dignity and personal autonomy. Community leaders emphasize that gender-affirming care is recognized as medically necessary by all major medical associations, including the American Medical Association and the American Academy of Pediatrics. Removing access to such care increases health disparities and exacerbates risks for mental health challenges, substance use, and suicide .

At the same time, LGBTQ+ organizations across the country are mobilizing to provide resources, support, and legal assistance to individuals affected by the new rules. Some clinics and advocacy groups are seeking alternative funding sources to continue providing care, while legal teams prepare to challenge the changes in federal court.