On August 11, the Trump Administration placed a final rule from the Centers for Medicare & Medicaid Services titled Medicaid Program; Prohibition on Federal Medicaid and Children’s Health Insurance Program Funding for Sex-Rejecting Procedures Furnished to Children on public inspection.

It is scheduled for formal publication in the Federal Register on August 13, 2026.

Let us begin by refusing the premise embedded in the title.

Gender-affirming health care is not a “sex-rejecting procedure.”

Transgender young people are not rejecting their bodies, rejecting reality, or rejecting their sex. They are human beings receiving health care in consultation with families and medical professionals.

The language chosen by this Administration is not incidental. It is part of the policy.

When a government wants to take rights away from a group of people, one of its first moves is often linguistic: rename the people, redefine their experiences, describe their health care as dangerous, and then present discrimination as protection.

That is precisely what we see in this document.

The Human Rights Alliance of Santa Fe condemns this rule unequivocally.

This is not simply a disagreement over Medicaid reimbursement.

It is an attempt by the federal government to use economic power to interfere with health care decisions involving transgender and Gender Expansive young people, their parents and guardians, and their medical providers.

And because Medicaid overwhelmingly serves Americans who have fewer financial resources, the burden will not fall equally.

Wealthier families may be able to pay privately, change insurance coverage, travel, or find other options.

Low-income families may not.

That transforms this policy from discrimination into something even more troubling: health care rationed according to both identity and economic status.

WHAT THE RULE ACTUALLY DOES

The final rule prohibits State Medicaid programs from making payment under their Medicaid plans for what CMS calls “sex-rejecting procedures” for people under 18 and prohibits federal Medicaid matching funds for those services.

For separate CHIP programs, the prohibition extends to people under 19.

The rule specifically encompasses pharmaceutical and surgical interventions intended to align a person’s body with a gender identity different from what the rule defines as the person’s sex.

For young people already receiving hormone therapy, federal financial participation may continue for only a transition period of up to six months following the rule’s effective date.

In other words, this is not merely prospective.

Young people who are already receiving care may face disruption.

Imagine being a teenager whose health care has been carefully managed by physicians and supported by your family, only to have the federal government announce that it knows better than your doctors, your parents and you.

That is not limited government.

That is extraordinary government intrusion into the examination room.

THE LANGUAGE TELLS US WHAT THIS IS REALLY ABOUT

Perhaps one of the most revealing portions of the rule appears near the end, where CMS formally defines “female,” “male” and “sex.”

The rule declares sex to be an “immutable biological classification” of either male or female and constructs its definitions around reproductive function.

Then it defines gender-affirming medical interventions as “sex-rejecting procedures.”

This should concern every LGBTQIA2S American.

The federal government is not simply deciding whether a particular medical service qualifies for reimbursement. It is using health-care regulation to impose an ideological definition of sex and gender across federal programs.

That distinction matters.

Because once government agencies establish the principle that LGBTQIA2S identities may be administratively redefined for the purpose of excluding people from public programs, there is no reason to assume the principle will remain confined to Medicaid.

Health care today.

Education tomorrow.

Housing.

Identification documents.

Employment.

Federal benefits.

Civil-rights enforcement.

We should take the Administration at its word when it tells us what framework it intends to build.

THE HYPOCRISY BUILT INTO THE RULE

There is another extraordinary feature of this regulation.

The rule does not prohibit these medications or procedures categorically.

It prohibits them when they are used for a particular purpose.

A medication may remain medically acceptable for one young person while federal reimbursement disappears when substantially the same medication is prescribed as gender-affirming care.

The regulation even contains exceptions for procedures treating certain disorders of sexual development and for interventions performed for purposes other than aligning the body with a gender identity different from the government’s definition of sex.

That distinction exposes the central problem.

The government is not simply regulating a drug.

It is regulating why the patient receives it.

And the disfavored purpose is gender affirmation.

That is why HRA views this rule as discriminatory at its foundation.

THE GOVERNMENT ADMITS STATES CAN CONTINUE THE CARE

There is also an enormously important fact buried beneath more than 200 pages of regulatory argument:

The rule does not prohibit states from paying for this care themselves.

CMS expressly acknowledges that states may continue providing these services using state-only funding outside the federally matched Medicaid or CHIP programs.

That admission matters enormously for New Mexico.

Washington is essentially telling states:

If you insist upon caring for these young people, you may have to pay for it yourselves.

Very well.

Then New Mexico must begin preparing to do exactly that.

NEW MEXICO ALREADY CHOSE A DIFFERENT PATH

New Mexico has not been silent about gender-affirming health care.

Our Legislature enacted the Reproductive and Gender-Affirming Health Care Freedom Act, which defines gender-affirming health care broadly to include psychological, behavioral, surgical, pharmaceutical and medical care, services and supplies supporting a person’s gender identity.

More importantly, New Mexico law prohibits public bodies from directly or indirectly denying, restricting or interfering with a person’s ability to access or provide gender-affirming health care within the medical standard of care.

New Mexico has also enacted the Reproductive

and Gender-Affirming Health Care Protection Act, protecting patients and providers from certain out-of-state civil and criminal actions related to legally provided gender-affirming care.

Those laws do not magically nullify federal Medicaid regulations.

But they tell us something tremendously important:

New Mexico has already established its public policy.

Our state has chosen access over prohibition.

Medicine over ideology.

Family decision-making over government interference.

Dignity over discrimination.

Now we must defend that choice.

WHAT NEW MEXICO SHOULD DO

HRA calls upon Governor Michelle Lujan

Grisham, the New Mexico Legislature, the New Mexico Health Care Authority and the New Mexico Department of Justice to begin preparing an immediate, coordinated response.

First, New Mexico should examine every available legal avenue for challenging this regulation. The final rule itself acknowledges existing federal litigation and injunctions concerning earlier Trump Administration efforts to condition federal funding on the provision of gender-affirming care. It also acknowledges that a federal court in Oregon previously determined that HHS lacked statutory authority for a related declaration concerning standards of care. This rule attempts to establish a different legal foundation.

That does not mean its legal foundation is unassailable.

New Mexico should be prepared to litigate alongside other states where appropriate, including seeking preliminary injunctive relief before families experience interruptions in care.

Second, New Mexico should immediately determine the fiscal cost of replacing lost federal matching funds with state dollars.

CMS itself acknowledges that states remain free to provide this care using state-only funding. Then we should find out what that costs.

And we should fund it.

If Washington’s strategy is to force New Mexico to choose between money and transgender children, then New Mexico’s answer should be remarkably simple:

We choose our children.

Third, the Legislature should consider establishing a dedicated Gender-Affirming Health Care Access Fund capable of maintaining continuity of care when federal reimbursement is withdrawn. That fund should prioritize Medicaid and CHIP beneficiaries, rural families, low-income households and patients already undergoing treatment.

No young person should wake up one morning and discover that their treatment disappeared because politicians hundreds or thousands of miles away decided their identity was politically inconvenient.

Fourth, New Mexico should strengthen protections for medical providers.

Doctors, nurses, psychologists, pharmacists, social workers and health-care institutions should know that our state stands behind providers practicing within lawful professional standards.

Fifth, New Mexico must expand access outside Albuquerque and Santa Fe.

This rule may be especially damaging in rural communities, where provider shortages already create enormous barriers.

CMS itself acknowledges comments warning that the effects of this rule may fall disproportionately upon rural beneficiaries, people with disabilities, Tribal communities, foster youth and justice-involved youth. That should be particularly alarming in New Mexico.

A state-level response cannot merely preserve care theoretically.

We must preserve care geographically and practically.

WHAT COMMUNITIES CAN DO

This cannot be a fight conducted only by attorneys general and legislators.

LGBTQIA2S organizations, medical associations, parents, educators, faith communities, civil-rights organizations and ordinary New Mexicans need to organize now.

We need to document disruptions in care. We need families willing, when safe and appropriate, to tell their stories.

We need physicians explaining publicly what political interference in medical decision-making actually looks like. We need New Mexicans contacting state legislators and demanding state funding to replace federal dollars if necessary.

We need philanthropy prepared to establish emergency bridge funding.

We need legal organizations prepared to represent families.

We need our congressional delegation challenging the Administration’s authority and demanding oversight.

And we need every transgender and Gender Expansive young person in New Mexico to hear something louder than the cruelty coming from Washington:

You belong here.

You are not a political problem.

You are not an ideology.

You are not a diagnosis to be debated on cable television.

You are part of our families, our classrooms, our pueblos, our neighborhoods, our churches, our communities and our future.

THIS IS ALSO ABOUT ECONOMIC JUSTICE

We must resist the temptation to discuss this solely as an LGBTQIA2S issue.

It is also an economic justice issue. The regulation does not prevent a wealthy family from purchasing care privately. It removes federal support from families relying upon Medicaid and CHIP.

That means the practical dividing line may become money.

One transgender teenager may continue receiving medically recommended treatment because their parents can afford thousands of dollars in private expenses.

Another may lose access because their family lives paycheck to paycheck.

Same diagnosis.

Same doctor.

Same treatment.

Different bank account.

Different outcome.

That is not health policy worthy of the United States of America.

AND LET US BE VERY CLEAR ABOUT “PARENTAL RIGHTS”

We have heard the phrase “parental rights” invoked endlessly in political campaigns targeting LGBTQIA2S young people. Apparently those rights become remarkably negotiable when parents support their transgender child.

A parent may supposedly have the right to remove a library book.

The right to complain about a pronoun.

The right to object to a classroom lesson.

But when a parent sits with their child and a physician and makes a medical decision based upon that child’s individual needs, suddenly Washington knows best.

That is not parental rights.

That is ideological compliance masquerading as parental rights.

Real respect for families includes respecting families whose decisions politicians dislike.

WE HAVE SEEN THIS STRATEGY BEFORE

History teaches us that governments rarely begin discrimination by announcing its ultimate destination.

They begin administratively.

A definition changes.

A benefit disappears.

A category of people becomes an exception.

A bureaucratic term replaces a human one.

A government document explains, in hundreds of pages of technical language, why treating one group differently is supposedly reasonable.

Then the next restriction becomes easier.

And the next.

That is why HRA refuses to treat this as merely another regulation appearing in the Federal Register.This is part of a broader federal campaign to erase transgender people from public life and to use the machinery of government to make their lives increasingly difficult.

We will not normalize it.

We will not sanitize it.

And we will not pretend that cruelty becomes compassionate simply because someone places it in the Code of Federal Regulations.

OUR MESSAGE TO WASHINGTON

New Mexico has spent years building legal protections for LGBTQIA2S people and for gender-affirming health care.

We are not surrendering them because an Administration has discovered another regulatory mechanism for targeting transgender Americans.

If federal officials want to test whether New Mexico’s commitment to human dignity disappears when federal money is threatened, they are welcome to conduct that experiment.

They may discover that our commitment runs considerably deeper than they imagine.

The Human Rights Alliance calls upon our state government to fight this rule in court, prepare state funding to preserve care, protect providers, strengthen access in rural communities, and coordinate with other states defending evidence-informed medical decision-making.

And we call upon New Mexicans to prepare for the work ahead.

Call your legislators.

Contact the Governor.

Support organizations providing LGBTQIA2S services.

Support transgender-led organizations.

Support affirming health-care providers.

Show up at hearings.

Submit testimony.

Donate to legal-defense and patient-support efforts. (Lambda Legal)

Tell the stories Washington would prefer remain invisible.

And vote.

Above all, refuse the oldest trick in the political playbook: convincing us that a small and vulnerable group of people is responsible for problems they did not create.

Transgender children are not the enemy.

Their parents are not the enemy.

Their doctors are not the enemy.

A teenager trying to live authentically is not a threat to the Republic.

But a government willing to use access to health care as leverage against a politically unpopular minority should concern every person who values civil liberty.

Because human rights that depend upon being popular are not human rights at all.

Here in New Mexico, our answer must be unmistakable:

Not here.

Not our children.

Not our families.

Not our neighbors.

And not without one hell of a fight.

The Human Rights Alliance of Santa Fe

Standing for dignity, equality, bodily autonomy, and the human rights of LGBTQIA2S New Mexicans.