Maryland Attorney General Challenges Federal Proposals Restricting Gender-Affirming Care for Minors

Maryland Attorney General Anthony G. Brown has voiced strong opposition to three recently proposed federal rules that would significantly limit access to gender-affirming care for young people. These proposals, put forth by the Trump administration, target federal reimbursement for such care, participation of providers in federal health programs, and the definition of disability under federal law. The Attorney General’s office has indicated it will utilize all available legal avenues to contest these measures, emphasizing the potential harm to vulnerable youth and healthcare providers in Maryland.

The first of the contested rules, referred to as the Reimbursement Rule, seeks to eliminate federal funding for gender-affirming care for individuals under 18 enrolled in Medicaid and under 19 in the Children’s Health Insurance Program (CHIP). Simultaneously, the Condition of Participation Rule would prevent healthcare providers who offer gender-affirming care to minors from participating in the Medicare and Medicaid programs. This could force healthcare institutions in Maryland to choose between adhering to federal funding requirements or continuing to provide essential care to young transgender patients. A third proposal, the Disability Exclusion Rule, aims to redefine disability within regulations implementing the American with Disabilities Act (ADA) to specifically exclude gender dysphoria.

These proposed federal actions stand in contrast to Maryland’s existing legal framework. State law mandates that the Maryland Medical Assistance Program, which operates as Maryland’s Medicaid program, must provide gender-affirming care in a manner that prohibits discrimination. Furthermore, Maryland law requires that medically necessary gender-affirming care be covered by the Medical Assistance Program. Information regarding LGBTQ+ protections under Maryland law is accessible on the Attorney General’s website.

The U.S. Department of Health and Human Services is currently accepting public comments on the Reimbursement Rule and the Condition of Participation Rule, with a comment period of 60 days. The Disability Exclusion Rule has a public comment period of 30 days.

Attorney General Brown’s opposition to these federal proposals is part of a broader pattern of legal action aimed at protecting access to gender-affirming care. Earlier this month, he joined a coalition of 20 state attorneys general in filing an amicus brief against a subpoena issued by the U.S. Department of Justice that sought private medical records related to gender-affirming care at Children’s Hospital Colorado. This follows similar amicus brief filings in October concerning subpoenas for patient records at Boston Children’s Hospital and Children’s Hospital of Philadelphia. In August, Attorney General Brown was also part of a multistate coalition that filed a lawsuit challenging an executive order from the Trump administration. That executive order had threatened providers with civil and criminal prosecution for offering medically necessary gender-affirming care to individuals under 19, employing what the coalition deemed specious legal theories.

Article by Mel Anara, based upon information from the Maryland Attorney General’s Office.

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