New York State Budget Released: $0 For Transgender Care Access

Advocates wanted the state budget to support access to care as hospitals capitulate to the Trump administration.

NY Gov Kathy Hochul // Wikimedia Commons // MTA

Since Trump took office for his second term, his administration's attacks on hospitals that provide gender-affirming care for transgender youth have significantly disrupted that care. In response, advocates have pushed blue states that claim to support transgender people to step in and fund care directly. That has been especially true in New York, where advocates spent the legislative session pushing for a dedicated gender-affirming care fund—an access program designed to help outpatient providers absorb the patients pushed out of hospitals that abandoned care. The need has grown more urgent as New York City, whose mayor made his own promises to fund gender-affirming care and hold hospitals that capitulate accountable, has likewise failed to deliver for the transgender community. Now the state budget has passed, and it contains exactly zero dollars for the critical priorities advocates spent months asking for.

“As the Trump administration continues to pose an existential threat to the transgender community, we are profoundly disappointed that the FY2027 New York State budget invests zero state dollars to support access to the health care many transgender, gender non-conforming, nonbinary, and intersex people rely on to live in their bodies with dignity and health -- a complete failure to meet the moment,” said Allie Bohm, NYCLU senior policy counsel about the lack of passage. “We urge our lawmakers and the Governor to take urgent action to restore New York's reputation as a beacon for gender-affirming care access by codifying New York's insurance coverage requirement for gender-affirming care, strengthening our health care anti-discrimination laws, enacting robust health privacy protections both for electronic health records and for consumer health data, and advancing hospital transparency.”

The major ask from advocates was the creation of a dedicated gender-affirming care fund—a state-run access program that would help outpatient providers absorb the patients shut out when hospitals like NYU Langone abandoned care. One proposal would have distributed money to clinics and providers continuing to offer care, including those that had lost federal funding for refusing to stop. "Creating and funding the Gender-Affirming Care Access Program would send a clear message: New York believes that access to essential healthcare is a matter of dignity, freedom and justice," Assemblymember Jessica González-Rojas wrote in an April op-ed urging lawmakers to include it in the budget. Notably, a similar (though small) bill passed in Massachusetts, which established exactly such a backstop in 2025, when Gov. Maura Healey signed a Gender-Affirming Care Trust Fund into the state budget to pay for transgender health care in the event federal funding is cut off.

This comes as a growing number of hospitals have shut down care for transgender people nationwide. A STAT News analysis found that more than 40 hospitals across the country have paused or stopped offering some form of gender-affirming care to trans youth since Trump issued his first executive order. In these cases, hospitals are capitulating preemptively, out of fear of losing the Medicare and Medicaid funding the Trump administration has threatened to withhold, even before any rule allowing him to do so has taken effect. In New York, that capitulation is almost certainly illegal: Attorney General Letitia James warned hospitals early last year that denying care to transgender patients while providing it to others violates the state's anti-discrimination laws. But those laws have gone largely unenforced, and hospitals like NYU Langone have shuttered their programs anyway, with no apparent consequence. A dedicated state fund—or direct provision of care through public hospitals—would at least offer transgender New Yorkers a second avenue to treatment, one that does not depend on the state successfully compelling private hospitals to follow a law it has so far declined to enforce.

The state budget is not the only place where New York's elected leaders have failed to act. New York City Mayor Zohran Mamdani campaigned on a $65 million pledge to fund gender-affirming care through public hospitals and community clinics, but Prism reported that the money did not appear in his February preliminary budget, with the city's Independent Budget Office unable to locate the funds and the mayor's office declining to say where they were. He also has not demanded the city's public hospital system, NYC Health + Hospitals to expand access, and has not coordinated with state officials to hold noncompliant hospitals accountable. Writing in The Nation, Sophie Hurwitz noted that despite his promises—and despite his having personally protested NYU Langone's capitulation as a candidate—"many of his promises to the trans community have yet to become reality."

Though New York sells itself as a sanctuary state—and its laws do protect transgender people to a degree unmatched in most of the country—it is, for now, likely to be seen as falling short for its transgender residents. With the state budget finished, the dedicated care fund advocates wanted would now have to come through separate legislation, which the legislature could still take up before it adjourns. New York City's budget, meanwhile, is not yet settled. Mamdani's spending plan is still being negotiated with the City Council ahead of its summer deadline, leaving a narrow window for the gender-affirming care funding he promised to finally appear—and for at least one level of New York government to match its rhetoric with action.