(The Center Square) – A recent ruling from the U.S. Department of Health and Human Services is forcing states, including Colorado, to prohibit the use of federal Medicaid funds and certain children’s health insurance programs for “sex-rejecting” procedures on minors.
The ruling came on Aug. 13 from the department’s Center for Medicare and Medicaid services and requires state Medicaid plans “must provide that the Medicaid agency will not make payment under the plan for sex-rejecting procedures for children under 18.”
A Colorado state official, meanwhile, told The Center Square that the state’s money can’t be used to make up for the loss of federal funding unless the Legislature acts. The Legislature, or General Assembly, ended this year’s session on May 13.
The federal ruling affects coverage for hormone therapy, including puberty blockers and other forms of gender-affirming procedures. It was challenged Wednesday by a lawsuit filed by Colorado and other states with Democratic attorneys general. The suit is being co-led by California, Illinois, Maryland, Connecticut and Massachusetts. Other plaintiffs are the attorneys general of Delaware, the District of Columbia, Hawaii, Maine, Michigan, Minnesota, Nevada, New Jersey, New York, Oregon, Rhode Island, Vermont, Virginia, Washington, and Wisconsin, and the governor of Pennsylvania.
Colorado will begin implementing the order on Oct. 13, the same day the federal rule goes into effect.
According to a database from an organization called Do No Harm, which was started by Dr. Stanley Goldfarb in 2022, the number of minors who received gender or sex-related care in Colorado was nearly 300. It also shows that 60 of them have been impacted specifically by sex-rejecting surgeries. These numbers are from 2019 to 2023.
Dr. Kurt Miceli, the chief medical officer for Do No Harm, told The Center Square that this number was “likely an underestimate.”
He cited court documents from earlier this year that show Children’s Hospital Colorado’s TRUE Center, which provides healthcare services to LGBTQ+ families, prescribed puberty blockers to more than 250 minors and cross-sex hormones to nearly 550 minors in 2024 and 2025.
Denver Health, a medical center that also performs sex-rejecting procedures and surgeries, referred The Center Square to its press statement earlier this year, which said “Denver Health has made the difficult decision to suspend gender affirming care to youth, including puberty blocking prescriptions and hormone therapy; surgeries were stopped early in 2025.”
It also said that the Centers for Medicare and Medicaid ruling “substantially affect[s] access to critical health services.”
Health and Human Services Secretary Robert F. Kennedy Jr. stated the goal of the rule in a press release earlier this month, saying “[t]he federal government will no longer use Medicaid and CHIP dollars to fund procedures that fail to meet the evidentiary standard our children deserve.”
This decision comes as part of the Trump’s administration’s broader efforts to eliminate most forms of gender-affirming care for minors.
The Centers for Medicare and Medicaid director, Dr. Mehmet Oz, was directed by President Donald Trump to enact these restrictions. Trump later wrote in a Truth Social post that “[w]e are not going to pay for our innocent children to undergo these barbaric surgeries and practices, which result in unthinkable and irreversible harm to their young bodies.”
The centers have argued they have the authority to determine how Medicaid and CHIP dollars are spent under Title XIX and Title XXI of the Social Security Act.
The Colorado Department of Health Care Policy and Financing. which administers healthcare funding in the state, said it does not have the budget nor statutory authority to cover these services without federal funding.
Marc Williams, the department’s public information officer, told The Center Square that “any ability to resume coverage of gender-affirming care for children and youth using state-only resources would require legislative action and additional funding.”
The Center Square reached out to members of the Legislature to see if any were planning a bill to allocate state funds for these procedures, but they did not respond. The state currently remains in deep controversy over budgets set by the Democratic-majority Legislature as it faces a $1.5 billion dollar deficit for the 2026-2027 fiscal year.
Despite a federal judge vacating a similar rule brought by the Department of Health and Human Services earlier this year, the Centers for Medicaid and Medicare said this new rule complies with the Administrative Procedure Act, which a federal judge argued the department previously violated.
The new rule is separate from the now-void Kennedy Declaration and does not regulate the nationwide standard for private medical practice. Oregon-based U.S. District Judge Mustafa Kasubhai last spring struck down the health and human services secretary’s declaration that gender-affirming medical care for minors is unsafe.
