Colorado will suspend Medicaid coverage for hormone therapy and other gender-affirming care for transgender youth due to a new federal rule, the state agency that oversees the program said.
The rule, finalized earlier this month, blocks federal funds from being used to pay for the care for youth. Specifically, the rule applies to coverage for people under 18 who are covered by Medicaid and people under 19 who are covered by a companion program called CHIP, which in Colorado is known as CHP+.
The rule affects coverage for hormone therapy and puberty blockers, as well as other procedures. It does not, however, apply to behavioral healthcare.
Colorado’s coverage suspension will begin Oct. 13 to match when the federal rule takes effect. Under the federal rule, patients taking hormones will continue to have coverage for a six-month-long tapering period.
In a statement, the Colorado Department of Health Care Policy and Financing, which administers Medicaid in the state, said it is “working on a plan to support impacted members and their providers through these changes, in coordination with the Attorney General’s Office.”
“Any ability to resume covering gender affirming care will require legislative action,” the department added.
In the 2024-25 fiscal year, about 500 people under the age of 19 received hormone therapy covered by Medicaid as part of gender-affirming treatment in conjunction with a diagnosis of gender dysphoria, according to the department, which is known as HCPF. That is the most recent year for which complete data is available.
A handful of people also received other types of gender-affirming care that the department lumped under the categories of either “procedures,” which generally refers to services provided by a doctor, or “inpatient,” which covers services provided at hospitals. The inpatient category could include gender-affirming surgeries, though it is unclear if it does in this case because HCPF did not provide a detailed breakdown of the claims.
The department did not provide similar data for youth covered by CHP+.
Colorado covers around 450,000 children on Medicaid, meaning the number of young people receiving hormones for gender-affirming care makes up about 0.1% of the total caseload.
Another 70,000 people are enrolled in CHP+, which also provides coverage to pregnant women.
The cost to provide the coverage is not huge compared with HCPF’s overall budget, which stood at roughly $16 billion in the 2024-2025 fiscal year and is now up to more than $20 billion.
In 2024-2025, Colorado’s Medicaid program spent a little under $1.3 million on gender-affirming care for people under the age of 19, according to figures provided by HCPF. Of that, about $700,000 came from federal funds.
In the six fiscal years starting in July 2019 and ending in June 2025, Medicaid spent a total of $7.1 million on gender-affirming care, including $4.2 million in federal funds, according to the department.
Colorado could choose to work around the new federal rule by paying for gender-affirming care in Medicaid and CHP+ entirely with state dollars. And those amounts are typically well within HCPF’s budget to absorb, despite the agency’s much-discussed spending challenges.
But to do that, the department would need legislative authorization, which could not happen until lawmakers are back in session — in January, barring a special session being called.
“The Colorado Department of Health Care Policy and Financing does not have the statutory or budget authority to cover these services without federal funding,” the department reiterated in its statement.
The administration of President Donald Trump issued the new rule about gender-affirming care — which it refers to as “sex-rejecting procedures” — because it says the treatments are unsafe and not proven to be beneficial. The new rule is part of an administration-wide campaign to crack down on gender-affirming care for youth, which includes sending subpoenas and threatening punishment to hospitals, as well as releasing a report last week titled “Wolves in White Coats.”
“Children deserve our protection, not experimental interventions that pose serious risks and convey no proven benefits,” Dr. Mehmet Oz, the head of the Centers for Medicare & Medicaid Services within the U.S. Department of Health and Human Services, said in a statement. “By cutting off federal funds for these sex-rejecting procedures, we’re following the science, saving taxpayer dollars, and, most importantly, protecting children from potentially irreversible harm so they can truly flourish.”
Major medical organizations dispute this, including the American Medical Association, which says it supports access to evidence-based gender-affirming care. The association, though, recently agreed with another group that gender-affirming surgeries should generally be deferred until adulthood.
The Human Rights Campaign called the new federal rule outrageous.
“The Trump administration is terrorizing trans youth and their families with these kinds of actions, and it has to stop,” Kelley Robinson, the organization’s president, said in a statement.