On Thursday, the Trump administration’s Department of Health and Human Services, under Secretary Robert F. Kennedy Jr., released a new proposed rule that represents the single most aggressive attack on transgender healthcare in U.S. history.

The rule—effectively a “nuclear option” from the administration—relies on expansive and legally dubious authority to restrict Medicaid funding through what are known as “conditions of participation.” Rather than directly banning Medicaid reimbursement for transgender care, the rule would bar any hospital that accepts Medicaid funding from providing gender-affirming care for trans youth at all, regardless of whether that care is paid for by Medicaid.

By making this a baseline condition for participation in the program, the administration appears to be weaponizing Medicaid itself to enact a de facto national ban on transgender youth care…

This goes far beyond a simple ban on Medicaid reimbursement for transgender youth care. Instead, it functions as a direct threat to any hospital that continues to offer such care at all, regardless of funding source, and its adoption would likely force every hospital and major clinic that relies on Medicaid to immediately cease providing transgender youth care.