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Medicaid Program; Prohibition on Federal Medicaid and Children's Health Insurance Program Funding for Sex-Rejecting Procedures Furnished to Children
Plain English Summary
A new rule has been established that affects Medicaid and Children's Health Insurance Program (CHIP) funding. States can no longer use Medicaid or CHIP funds to pay for sex-rejecting procedures for children under 18 and 19, respectively. This means that these procedures will not be covered for minors. However, if a child is currently receiving cross-sex hormone therapy, states can still receive federal funding for those medications for up to six months after this rule takes effect. Agents should ensure they understand these changes and inform their clients accordingly.
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This final rule requires that a State Medicaid plan must provide that the Medicaid agency will not make payment under the plan for sex-rejecting procedures for children under 18, and prohibits the use of Federal Medicaid dollars to fund sex-rejecting procedures for individuals under the age of 18. In addition, this final rule requires that a separate State Children's Health Insurance Program (CHIP) plan must provide that the CHIP agency will not make payment under the plan for sex-rejecting procedures for children under 19, and prohibits the use of Federal CHIP dollars to fund sex-rejecting procedures for individuals under the age of 19. For Medicaid and CHIP beneficiaries who are actively receiving cross-sex hormone therapy, State Medicaid and CHIP agencies may continue to claim Federal Financial Participation for those hormone therapy medications for a period of up to 6 months from the effective date of this final rule.