Massachusetts has vowed to assume the full cost of gender-affirming healthcarefor transgender children and teenagers covered by the state’s Medicaid and CHIP programs if a new Trump administration rule takes effect this October.

The federal rule, finalised Tuesday (11 August), would prohibit Medicaid and Children’s Health Insurance Program funds from being used for gender-affirming healthcare for people aged 18 and under.

The Trump administration’s Medicaid administrator, Dr Mehmet Oz, described the treatments as harmful and “sex-rejecting procedures” in a statement, while major medical organisations continue to support gender-affirming care as appropriate treatment for some transgender young people.

The federal government currently covers around 50 per cent of Medicaid costs for children and 65 per cent of CHIP costs. Massachusetts says it will use its Affirming Health Care Trust Fund to make up the difference if federal funding is cut off. As reported by Boston public radio station WBUR, legislative leaders have said that the fund held $8.5million as of July.

MassHealth spent $3.6million on gender-affirming care for members aged 18 and under in 2024, with more than $2.6million going toward hormone therapy. It remains unclear whether the state will also cover puberty blockers under the new arrangement.

The Healey administration said it is committed to ensuring Massachusetts residents can continue to access gender-affirming healthcare. “President Trump continues to attack the health and wellbeing of all people,” Gov. Maura Healey told GBH News in a 13 August statement. “Here in Massachusetts, we are going to keep working with providers to make sure that everyone – including LGBTQ residents – can get the essential health care they need.”

Attorney General Andrea Campbell called the federal rule “unlawful” in a 12 August statement and said the state plans to challenge it in court.

The federal changes are currently scheduled to take effect on 13 October, with a six-month tapering period for young people already receiving hormone therapy. Mental healthcare for transgender MassHealth and CHIP members would not be affected.