A federal rule that took effect October 13 ended Medicaid and CHIP funding for hormonal and surgical gender-transition procedures for minors. The Centers for Medicare & Medicaid Services finalized the rule in August. It covers Medicaid patients under 18 and CHIP patients under 19.
Virginia stopped coverage the day the rule took effect. Pennsylvania and Delaware chose a different path. Both states say their own budgets will now pay for what federal programs no longer will.
What the Federal Rule Does
The rule stops federal dollars from paying for puberty blockers, cross-sex hormones, and transition surgeries for children. Patients already taking hormones can receive up to six months of continued reimbursement. Mental health services such as talk therapy are untouched.
The rule does not stop a state from paying with its own money. That gap now decides how much protection children actually receive. A federal safeguard holds only in states willing to let it hold.
Pennsylvania and Delaware Choose to Keep Paying
Gov. Josh Shapiro's office says Pennsylvania will use state dollars to cover puberty blockers and hormones for children enrolled in Medicaid. State law blocks the same move for CHIP. In fiscal year 2024-25, Pennsylvania's Medicaid program spent about $11.9 million on gender-transition care for adults and youth combined, according to the state's Department of Human Services.
Delaware Gov. Matt Meyer has gone further. His spokesperson said the state is "committing state funds to replace the lost federal funding in full."
Those decisions move the entire cost onto state taxpayers. They also put a state government's own name on drugs that interrupt a child's natural development, at the very moment Washington concluded public money should step away.
Virginia Weighs the Same Choice
Virginia's Medicaid and CHIP programs ended coverage on October 13. Gov. Abigail Spanberger says her administration is "looking at every option available." State Sen. Danica Roem wrote that "Virginia should step up to help."
Virginia lawmakers are being asked to replace a federal funding stream with one paid entirely by Virginians. Meanwhile, a coalition of 21 states and the District of Columbia, including Pennsylvania and Delaware, has sued to overturn the rule. Those states are fighting in court to restore federal payment while preparing to spend their own residents' money if they lose.
A Lesson for Missouri
Missouri law already bars these drugs and surgeries for minors, so the state has no program to backfill today. Harrisburg and Dover show why that protection has to be durable. When Washington draws a line for children, a governor can erase it with a budget decision. A state's own law determines whether its children are protected.
Missouri's statutory ban on hormones and blockers for minors is scheduled to expire in 2027. If it lapses, Missouri officials could face the same pressure Pennsylvania and Delaware answered by opening the state treasury.
Amendment 3 settles that question in the Missouri Constitution. A yes vote on November 3 keeps these interventions for minors off the table in Missouri, whoever might want to pay for them.
Link to story: CMS final rule in the Federal Register
Link to story: Philadelphia Inquirer, October 15 report on state responses
Link to story: Washington Blade, October 21 report on Virginia
Link to story: Missouri SAFE Act, Section 191.1720
