CMS Proposes Regulations on Medical Procedures for Minors Affecting Compliance
The Centers for Medicare & Medicaid Services (CMS) unveiled two proposed regulations on December 18, 2025, poised to significantly influence the provision of certain medical procedures for minors. Industry stakeholders have a deadline of February 17, 2026, to submit their feedback on these proposals, which could reshape regulatory compliance requirements.
Regulatory Proposals Affecting Minors
The initial proposed regulation, “Medicare and Medicaid Programs; Hospital Condition of Participation: Prohibiting Sex-Rejecting Procedures for Children,” aims to introduce a Condition of Participation (CoP) for hospitals certified under Medicare and Medicaid. This would prohibit treatments related to gender dysphoria for minors, including puberty blockers, specific hormones, and surgeries, with exceptions for medically verified disorders or non-identity-related purposes. This marks a critical compliance requirement for healthcare providers.
CoPs serve as federally mandated standards ensuring healthcare facilities meet quality and safety compliance to engage with Medicare and Medicaid. Noncompliance could lead to the termination of CMS agreements, posing substantial operational risks for hospitals delivering these healthcare services.
Impact on Medicaid and CHIP Funding
The second proposed rule, "Medicaid Program; Prohibition on Federal Medicaid and Children’s Health Insurance Program Funding for Sex-Rejecting Procedures Furnished to Children," seeks to stop state Medicaid and CHIP programs from financially supporting these procedures for minors. While states could independently fund these procedures, 27 states currently do not provide Medicaid coverage for such treatments in children.
The administration is prioritizing stringent regulatory oversight of medical care for minors, evident in federal resistance to certain medical interventions. Given historical precedence, these proposals could trigger several legal challenges, as federal regulations traditionally avoid directly affecting medical practice per 42 U.S. Code § 1395, which emphasizes medical autonomy.
Engagement and Legal Implications
The innovative use of CoPs prompts an important debate on the broader implications for future healthcare practices and the CMS’s regulatory span. These proposals are likely to face legal scrutiny, and healthcare providers are urged to engage through comment submissions and assess the ramifications of these rules.
Concurrently, the Office for Civil Rights has proposed updates to Section 504 of the Rehabilitation Act, clarifying that gender dysphoria unrelated to physical impairment does not classify as a disability. This aims to clarify that restricting procedures related to gender dysphoria is not automatic disability discrimination under federal law.
These regulatory advances are pivotal for healthcare providers to monitor, given their potential impact on service delivery and compliance obligations. Legal outcomes and policy shifts will invariably shape the operational landscape for healthcare management and insurance reimbursement concerning these medical services.