In an April 11 letter to state Medicaid directors, the Centers for Medicare & Medicaid Services (CMS) reminded states of Medicaid requirements regarding gender dysphoria treatment, particularly for children.
The letter challenges current treatments for gender dysphoria, discussing an increase in surgical procedures and use of puberty blockers and sex hormones for children, as well as long-term effects on youth.
CMS reminds state Medicaid programs that they have a responsibility to ensure payments are consistent with “efficiency, economy, and quality of care” and that covered care must be in the best interest of recipients, per Medicaid statue. Further, Medicaid regulations prohibit federal funding for services that will permanently render an individual incapable of reproducing, and federal financial participation is specifically prohibited for such procedures performed on a person younger than 21.
CMS also encourages states to review their drug utilization review (DUR) programs to ensure alignment with current medical evidence and federal requirements, including the discussed evidence on gender dysphoria. Additional guidance on DUR program approaches is forthcoming.
Contact Director of Policy Rob Nelb, MPH, at rnelb@essentialhospitals.org or 202.585.0127 with questions.
Author