Virginia's Medicaid program will stop covering puberty blockers, opposite-sex hormones and related surgeries for minors beginning October 13, 2026, the date a new federal funding rule takes effect.
What changes in Virginia
In a provider bulletin, the Virginia Department of Medical Assistance Services (DMAS) said that for dates of service on or after October 13, it "will no longer cover gender dysphoria services for Medicaid members under the age of 18, and CHIP members under the age of 19."
- Tapering: youth already receiving related medications as of October 13 may continue for up to six months to taper off. A service authorization is required.
- Mental health care: coverage remains in place without changes.
- Adults: not affected.
The federal rule behind it
DMAS cites a federal final rule from the Centers for Medicare & Medicaid Services (CMS), part of the U.S. Department of Health and Human Services.
- Rule: CMS-2451-F, "Prohibition on Federal Medicaid and Children's Health Insurance Program Funding for Sex-Rejecting Procedures Furnished to Children."
- Published: August 13, 2026. Effective: October 13, 2026.
- Scope: no federal Medicaid funds for these procedures for patients under 18, and no federal CHIP funds for patients under 19.
- Definition: "any pharmaceutical or surgical intervention that attempts to align a child's physical appearance or body with an asserted identity that differs from the child's sex."
- What remains: federal funding for mental health services, and a six-month taper for children already on opposite-sex hormones. States may still pay with their own funds.
CMS said the rule follows an HHS review that found significant evidence gaps and safety concerns, and cited the United Kingdom's Cass Review and restrictions adopted elsewhere.
How Virginia compares
States are responding differently. Virginia is ending coverage. Oregon and California have said they will continue paying for these services for minors using state-only funds. Colorado has said it will suspend coverage.
Legal challenge
On September 2, 2026, 20 state attorneys general, the District of Columbia and the governor of Pennsylvania filed suit against HHS and CMS in federal court in Massachusetts, arguing CMS exceeded its authority. Virginia is among the plaintiffs. As of October 12, no court had blocked the rule.