Federal funds for gender-transition care for Alaska minors on Medicaid end in October

Alaska families who cover their children through Medicaid or Denali KidCare will lose federal matching funds for hormonal and surgical gender-transition care starting Oct. 13, under a final rule from the Centers for Medicare and Medicaid Services. Children already on hormone therapy could keep federal funding for a tapering-off period of up to six months.

The rule cuts off the federal share of the cost for these treatments for minors, hormonal or surgical interventions the agency describes as intended to alter a child's physical characteristics to match their experienced gender. It applies to Medicaid patients under 18 and CHIP patients under 19, and CMS says it does not affect coverage of mental health services.

What the rule does not do is ban the care. It withdraws the federal match, and states may still cover the treatments with their own dollars. That decision falls to the Alaska Department of Health, which runs both programs, and it hasn't been established whether the state will use state-only funding to keep covering the low-income and rural families who rely on public insurance. Alaska has no ban of its own on the record, and the federal rule doesn't spell out how the state would wind down care for children already being treated.

CMS grounds the rule in an argument about the strength of the evidence. The agency points to a federal review of the research, England's Cass Review, and systematic reviews from Sweden, Finland and Norway that questioned the quality of the clinical guidelines behind pediatric gender care, and to the U.S. Supreme Court's 2025 decision in United States v. Skrmetti, which upheld a state ban on such treatments for minors. The agency frames the change as a check against care it considers insufficiently supported by evidence.

The American Public Health Association told the agency the proposal exceeds CMS's authority and violates Medicaid's requirement to cover care a child's treating provider finds medically necessary. The National Women's Law Center said it would strip federal funding for essential care for transgender youth. At a June Senate health committee hearing, Shannon Minter of the National Center for LGBTQ Rights said the treatments are reserved for adolescents with persistent, severe gender dysphoria and called withholding them "really quite cruel."

The rule caps a process CMS opened in February.