New York will use state funds to keep covering puberty blockers, cross-sex hormones and related surgeries for minors enrolled in Medicaid and Child Health Plus, according to guidance from the state Department of Health.
Background: the federal funding rule
A Centers for Medicare & Medicaid Services rule, CMS-2451-F, took effect October 13, 2026. It prohibits federal Medicaid funding for these procedures for patients under 18 and federal CHIP funding for patients under 19. Patients already receiving cross-sex hormones may be tapered off with federal funds for up to six months. States may continue coverage with their own funds.
New York's guidance
In a notice to Medicaid providers dated October 13, 2026, the Department of Health said providers "should continue to provide these Medicaid and CHP services as normal, which will be covered by state-only funding, consistent with the Federal Rule." It added: "The State is committed to ensuring that beneficiaries continue to receive these services."
The notice updates an October 2 version, which said billing guidance would follow. The updated notice tells providers to "continue to bill as usual" and says the department "will make the necessary system adjustments to ensure the State is in compliance with the Federal Rule."
The guidance does not say how many patients are affected or what the coverage will cost.
Other states
At least nine other states have announced they will continue coverage with state funds:
- California: a state-only grant program run by the Department of Health Care Access and Information (HCAI).
- Oregon: about 600 children on the Oregon Health Plan, paid directly by the state (Oregon Health Authority, Oregon Capital Chronicle).
- Washington: the Health Care Authority will pay with state-only funds (HCA notice).
- Massachusetts: paid from the state's $8.5 million Affirming Health Care Trust; about 550 MassHealth members 18 and under got hormones or puberty blockers last year (GBH News).
- Maryland: state money, as required by its 2023 Trans Health Equity Act (Maryland Medicaid).
- Illinois: state-only funds through June 30, 2027, then it goes to the budget process (Illinois HFS provider notice, as summarized by the Illinois Health and Hospital Association).
- Maine: claims paid with state-only funds, as state law requires (Maine DHHS).
- Vermont: state funds replace federal funds, with "nothing changing" for members (Vermont DVHA).
- New Mexico: puberty blockers and cross-sex hormones for ages 12 to 17 stay covered with state funds (NM Health Care Authority).
Virginia, Montana and Colorado have ended or suspended coverage:
- Virginia ended coverage on October 13 (Virginia DMAS).
- Montana ended coverage, with a taper for children already on cross-sex hormones (Montana DPHHS).
- Colorado suspended coverage until lawmakers act (Colorado Sun).
Legal challenge
New York is one of 21 states, along with the District of Columbia and the governor of Pennsylvania, that sued HHS and CMS over the rule on September 2, 2026, in the U.S. District Court for the District of Massachusetts. New York Attorney General Letitia James announced the state's participation. As of October 15, no court had blocked the rule.
*Cover photos: vial, U.S. Drug Enforcement Administration (public domain); scalpel, Dan Bollinger (CC BY-SA 4.0); both via Wikimedia Commons*