House Spending Bill Now Bans Medicaid For Transition Care For Adults

The provision was stricken late at night to appeal to hardline conservatives.

Photo by Louis Velazquez on Unsplash

Late Wednesday night, as the House debated Trump’s sweeping tax and spending bill—which will shape the federal government’s priorities for the coming year—Republican leaders made a last-minute concession to the party’s hard-right flank: expanding a provision banning Medicaid funds for transgender youth to now include all transgender people, regardless of age. The move marks a significant and unprecedented escalation—effectively the first major federal effort to restrict access to transition-related care for adults. It also confirms what many transgender advocates have long warned, and what some GOP operatives have candidly admitted: the endgame isn’t protecting children—it’s banning care for everyone.

The manager’s amendment came late Wednesday night, and changed a previous ban on “gender transition procedures for minors.” Notably, gender transition procedures is defined to include hormone therapy, see the following provision from the bill:

The manager’s amendment—reportedly introduced to win back support from hardline conservatives after concessions were made to the party’s more moderate wing—dramatically expands the scope of the Medicaid ban on transgender care. What was initially a restriction targeting gender-affirming care for minors now extends to transgender people of all ages. See the amendment language here:

The policy change could have devastating consequences for transgender people across the United States and is likely to clash with state laws that mandate insurance coverage for gender-affirming care. According to the UCLA Williams Institute, more than 152,000 transgender Americans currently rely on Medicaid for their care. Stripping that coverage would make surgeries cost-prohibitive for many, with procedures often running into the tens of thousands of dollars. Even routine hormone therapy and necessary bloodwork could become financially out of reach. For countless trans adults, this would mean either turning to unsafe alternative care or being forcibly taken off treatment—a process known as medical detransition. The effects can be severe, particularly for those who’ve already undergone surgery and require ongoing hormone supplementation, putting both mental and physical health at serious risk.

While shocking in its scope, the ban on Medicaid funding for transgender adults has been telegraphed for some time. Erin In The Morning was the first to report a leaked audio recording of Republican lawmakers from multiple states openly discussing their intent to “ban |transgender healthcare| for everyone,” explicitly including adults. The wave of legislation targeting transgender youth, athletes, and school policies was never the endgame—it was the opening act.

According to Bloomberg, the House vote on the full bill could come as soon as Thursday.