Trump Admin Bans Coverage For Trans Govt Employees, Mandates Conversion Therapy Coverage

The OPM memo states that all health plans for government workers must cover faith-based approaches to gender dysphoria while banning gender affirming care coverage.

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On Friday, the U.S. Office of Personnel Management issued a memo announcing that, beginning in 2026, all federal employee health plans will be barred from covering gender-affirming care—including hormone therapy and gender-affirming surgeries—for both transgender youth and adults. The sweeping prohibition affects health benefits for more than 10 million federal workers and their family members, marking one of the largest rollbacks of transgender healthcare access in U.S. history. Even more disturbing, the memo mandates that insurers cover “faith-based counseling” for transgender individuals, otherwise known as conversion therapy. Taken together, the provisions appear designed not just to strip access to necessary medical care, but to coerce federal workers into detransitioning or leaving public service altogether.

“For Plan Year 2026, chemical and surgical modification of an individual's sex traits through medical interventions (to include “gender transition” services) will no longer be covered under the FEHB or PSHB Programs. This exclusion expands upon Carrier Letter 2025-01a and applies regardless of age. As an exception, counseling services for possible or diagnosed gender dysphoria must still be covered. Covered counseling services must be provided by a licensed mental health provider and may include those who provide faith-based counseling,” reads the memo.

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The move appears to directly contradict longstanding interpretations of Section 1557 of the Affordable Care Act, which prohibits healthcare discrimination on the basis of sex. Under previous administrations, this provision has been used to mandate coverage of gender-affirming care for transgender people—both within the federal government and in several states with respect to Medicaid coverage. However, a recent Supreme Court decision, U.S. v. Skrmetti, opened the door to medical discrimination against transgender people by ruling that the denial of such care does not violate equal protection rights. The administration, likely emboldened by that ruling, appears to believe it can now strip gender-affirming care from employee health plans, including for adults, with impunity. If challenged, the administration may anticipate prevailing in a judicial system increasingly hostile to transgender people—setting the stage for yet another wave of legal battles that could shape access to care for years to come.

“This discriminatory policy denying medical care to government employees and their dependents is not only cruel—it is illegal,” said Lambda Legal Counsel and Health Care Strategist Omar Gonzalez-Pagan. “The federal government cannot simply strip away essential healthcare coverage from transgender employees while providing comprehensive medical care to all other federal workers. Beyond the fundamental equal protection guarantees enshrined in our Constitution, which prohibit such animus-laden actions, multiple federal laws also prohibit this type of discrimination. Title VII of the Civil Rights Act prohibits employment discrimination, including denying equal benefits to LGBTQ+ employees, as confirmed by the Supreme Court’s decision in Bostock v. Clayton County. Section 1557 of the Affordable Care Act bars discrimination on the basis of sex in federally funded health programs. The federal government cannot simply ignore and violate these laws.”

The inclusion of “faith-based counseling” signals a direct move toward legitimizing and even requiring conversion therapy for transgender people as the only option. Earlier this year, the administration released a rushed and ideologically driven report through the Department of Health and Human Services to justify sweeping bans on gender-affirming care nationwide. Commissioned under a Trump executive order that referred to transgender healthcare as “mutilation,” the report relied heavily on misinformation and junk science. Its conclusions were predetermined, serving not to assess evidence but to rationalize discrimination. Central to its recommendations was the endorsement of “psychotherapy” as the only treatment for being transgender, otherwise known as conversion therapy.

There is no evidence that “psychotherapy” or conversion therapy can treat gender dysphoria. On the contrary, the documented harms of conversion therapy are extensive: LGBTQ+ youth subjected to it are more than 2.5 times as likely to report multiple suicide attempts in the past year. Though many governments have banned conversion therapy for transgender people, some are reviving the practice. In Kentucky, Republicans passed a law overriding a conversion therapy ban this year. Meanwhile, Colorado’s conversion therapy ban is set to be heard by the Supreme Court.

For transgender federal employees and their families, the memo signals a chilling and deeply uncertain future. While it allows for vague, undefined exceptions for some of those currently receiving care, it is unclear how many will actually receive those exceptions. Furthermore, it strips provider directories of all gender-affirming clinicians, creating new logistical and psychological barriers to treatment. The expansion of the administration’s crackdown—now targeting not only youth but also adult transgender healthcare and mandating conversion therapy coverage—marks a dangerous escalation in its campaign to erase transgender people from public life. When combined with other restrictions for trans federal employees, it sends a clear message to those still in the closet seeking to come out: choose your livelihood, or choose your identity—but you can no longer have both.