Why Are Medicaid Funds Used for 'Gender-affirming Care'?

AP Photo/Rick Bowmer

The question having never occurred to me before, I decided to look into whether Medicaid funds (public money) are used in the service of “gender-affirming care” for the American public, particularly children.


First, here is a brief synopsis of Medicaid, via Kaiser Family Foundation:

Medicaid is the country’s health coverage program for low-income people and is jointly funded by the federal government and states. Under Medicaid, states must cover certain mandatory benefits, such as inpatient and outpatient services, home health services, and family planning services.

The gist of the language indicates that medically necessary care must be covered under Medicaid.

Related: Military Doctors Claim 7-Year-Olds Can Make Decisions About Puberty Blockers

In the last decade, lawyers representing “transgender” clients have filed numerous lawsuits against states that refuse to cover “gender-affirming care” procedures and drugs, such as this 2018 case from Iowa, via the Des Moines Register, 2018:

Two transgender women had filed a lawsuit challenging Iowa’s blanket Medicaid ban on transition-related care after years of dealing with denials and headaches regarding their health coverage.

Just hang on, Nisly told patient after patient, and a judge will decide if the right to transition-related care deemed medically necessary should override the state’s ban.

As of Thursday, the wait was over.

Chief District Judge Arthur Gamble ruled in favor of Carol Ann Beal of northwest Iowa and EerieAnna Good of the Quad Cities, agreeing that the state’s ban violated both the Iowa Civil Rights Act and the state constitution.


So, that ruling was based on Iowa’s state laws and constitution.

But, from a federal perspective, are surgical castration/mutilation (euphemistically termed “gender-affirming surgery”) and/or chemical castration (cross-sex hormones for adults and children and puberty blockers for children) covered as “mandatory benefits” under Medicaid?

Federal judges have also forced states to cover “transgender” healthcare, via Chicago Tribune, 2018:

A federal judge has ordered Wisconsin to pay for the gender reassignment surgery for two transgender Medicaid recipients.

The Milwaukee Journal Sentinel reports that Cody Flack, 30, of Green Bay and Sara Ann Makenzie, 41, of Baraboo filed a lawsuit in April, saying a state rule denying coverage for surgeries to treat gender dysphoria violates the Affordable Care Act and their right to equal protection.

The Biden administration concurs with the view that the federal government should force states to fund such practices, per Obama’s ACA and rules added by Biden’s handlers to encompass protected LGBTQ+++™ identities. Again, via Kaiser Family Foundation:

Medicaid benefits are subject to Section 1557 of the Affordable Care Act (ACA), the law’s major non-discrimination provisions, which prohibit discrimination based on sex. The Biden Administration recently proposed a new rule on Section 1557 that explicitly states that it interprets, and will enforce, sex-based protections to include sexual orientation and gender identity. The administration had already asserted this position in guidance stating that under 1557 protections, “categorically refusing to provide treatment to an individual based on their gender identity is prohibited discrimination” and it returns to a position more closely aligned to that under the Obama administration but walked back under the Trump administration.


Elective surgical and chemical mutilation is not necessary and should not be abetted by government funding. States that refuse to follow immoral federal directives in this regard are not unduly discriminatory. Repealing rules that require this sort of “healthcare” should be a legislative priority for the Republican-led House.


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