Centers for Medicare and Medicaid Services Administrator Dr. Mehmet Oz speaks at the Department of Health and Human Services in Washington, D.C., on Dec. 18, 2025. Oz and other Trump administration officials announced proposed rules that would limit gender-affirming care for minors. (Photo by Alex Wong/Getty Images)

WASHINGTON — President Donald Trump’s administration took major steps Thursday in a campaign to block minors’ access to gender-affirming care nationwide. 

Under two proposed new rules from the Centers for Medicare and Medicaid Services, hospitals would be barred from providing gender transition treatment for children as a condition of participating in Medicare and Medicaid programs, and Medicaid funding would be prohibited from being used to fund such care for minors. 

As most hospitals receive Medicare and Medicaid funding, the rules would essentially have the effect of a nationwide ban if they are finalized. 

The announcement came a day after the U.S. House passed a bill that would impose federal criminal penalties for gender-affirming care for minors and hours before it advanced a separate measure that would prohibit Medicaid funding for gender transition treatment for minors. 

The proposed regulations, which will next undergo a period of public comments, are certain to draw legal challenges.

The efforts build on Trump’s executive order in January that restricted access to gender-affirming care for kids. 

More than half of states already have laws or policies aimed at limiting youth access to gender-affirming care, according to the nonpartisan health research organization KFF. 

Health and Human Services Secretary Robert F. Kennedy Jr. and CMS Administrator Dr. Mehmet Oz announced the proposals alongside several other health officials at a press conference at HHS headquarters in Washington, D.C. 

The room featured a handful of GOP members of Congress. At least two Republican state attorneys general — Ken Paxton of Texas and Todd Rokita of Indiana — were also in attendance.

At the press conference, Food and Drug Administration Commissioner Dr. Marty Makary said the FDA is also sending “warning letters” to 12 breast binder manufacturers and sellers for “illegal marketing of breast binders for children for the purposes of treating gender dysphoria.” 

Breast binders are used to flatten tissue in the chest.  

Kennedy said his agency’s Office for Civil Rights is moving to “reverse the Biden administration’s attempt to include gender dysphoria within the definition of disability.” 

House passes anti-transgender bills 

The proposed rules are part of the Trump administration’s broader anti-trans agenda. 

Trump has signed executive orders that make it the “policy of the United States to recognize two sexes, male and female,” aimed to bar openly transgender service members from the U.S. military, and sought to prohibit trans athletes from competing on women’s sports teams consistent with their gender identity.

Meanwhile, efforts at the congressional level to restrict youth access to gender-affirming care face a dismal path in the Senate, where any legislation would likely need the backing of at least 60 senators to advance past the filibuster.

The House passed a measure Wednesday night, 216-211, that would subject medical professionals to up to 10 years in prison for providing gender-affirming care for minors. 

Rep. Marjorie Taylor Greene, who sponsored the legislation, called its passage a “win for children all over America,” in a social media post Wednesday. 

It’s likely the last legislative achievement for the Georgia Republican, who is resigning from Congress in early January. 

Four Republicans voted against the measure: Reps. Gabe Evans of Colorado, Brian Fitzpatrick of Pennsylvania, Mike Kennedy of Utah and Mike Lawler of New York.

Three Democrats voted with the GOP to back the bill: Reps. Henry Cuellar and Vicente Gonzalez of Texas and Don Davis of North Carolina.

The House also passed a measure Thursday, 215-201, from Texas GOP Rep. Dan Crenshaw and Greene that aims to prohibit “Medicaid funding for gender transition procedures for minors.” 

Cuellar, Gonzalez and Davis also backed the GOP-led bill, along with fellow Democratic Rep. Marie Gluesenkamp Perez of Washington state. 

‘Cruel and unconstitutional attacks’ 

Kelley Robinson, president of the Human Rights Campaign, an LGBTQ+ advocacy group, blasted the administration’s proposals, saying they “would put Donald Trump and RFK Jr. in those doctor’s offices, ripping health care decisions from the hands of families and putting it in the grips of the anti-LGBTQ+ fringe.”  

Robinson also emphasized that the rules are “proposals, not binding law,” and called on community members, health care providers, administrators and allies to “be vocal in pushing back by sharing the ways these proposals would be devastating to their families and the healthcare community at large.” 

The American Civil Liberties Union also condemned the administration’s proposals and vowed to challenge the efforts in court. 

Chase Strangio, co-director of the ACLU’s LGBTQ & HIV Rights Project, dubbed the proposals “cruel and unconstitutional attacks on the rights of transgender youth and their families.” 

Strangio said the proposals would “force doctors to choose between their ethical obligations to their patients and the threat of losing federal funding” and “uproot families who have already fled state-level bans, leaving them with nowhere to turn for the care they need to survive and thrive.”

Cows graze at Nice Farms Creamery in Federalsburg, Maryland.  (Photo by Preston Keres/USDA)

WASHINGTON — The U.S. Department of Agriculture will spend $700 million to support regenerative agriculture as part of the Make America Healthy Again agenda, Agriculture Secretary Brooke Rollins and Health and Human Services Secretary Robert F. Kennedy Jr. announced Wednesday. 

The USDA pilot program for regenerative agriculture — a conservation management approach centered on improving the health of soil and increasing biodiversity — enacts part of President Donald Trump’s administration’s September “Make Our Children Healthy Again Strategy,” which offered more than 120 recommendations for addressing childhood chronic diseases.  

The pilot program will take funding from existing USDA conservation programs, which provide financial and technical assistance to farmers, with the aim of improving soil health.

“Protecting and improving the health of our soil is critical, not only for the future viability of farmland, but to the future success of American farmers,” Rollins said at a press conference alongside Kennedy and Centers for Medicare and Medicaid Services Administrator Dr. Mehmet Oz. 

“In order to continue to be the most productive and most efficient growers in the world, we must protect our topsoil from unnecessary erosion and boost the microbiome of the soil,” Rollins said.

Kennedy said a September report from the administration’s Make America Healthy Again Commission, which the health secretary chairs, included “the promise to make it easier for farmers in this country, to give them an off-ramp — farmers who are dependent on … chemical and fertilizer inputs — to give them an off-ramp where they can transition to a model that emphasizes soil health.” 

Kennedy has long advocated against use of chemicals in farming.

Repurposing funding

The department will dedicate $400 million to the initiative through the department’s Environmental Quality Incentives Program and $300 million from its Conservation Stewardship Program, according to a USDA press release.

“It’s baseline funding that we received through our budget, so we have the ability to tag that funding specifically for this pilot, and that’s what we’re doing,” Aubrey J.D. Bettencourt, chief of USDA’s Natural Resources Conservation Service, or NRCS, said.

Rollins also said she would seek corporate partners for the program using a 2022 law that authorizes USDA to channel private contributions to conservation programs. 

The move “will bring corporate label and supply chain partners directly into partnership” with NRCS, Rollins said.

The pilot program “connects the producer and the work that they’re doing on the farm, granting them the credit for that voluntary action of change in practice on their farm that then can transition into the supply chain, into the marketplace and directly back to the consumer,” Bettencourt said. 

SNAP waivers 

Meanwhile, Rollins and Kennedy also announced Wednesday six more states whose waivers were approved to prohibit Supplemental Nutrition Assistance Program, or SNAP, benefits from being used to purchase certain non-nutritious items beginning in 2026. 

The effort, also part of the Make America Healthy Again agenda, adds Hawaii, Missouri, North Dakota, South Carolina, Virginia and Tennessee to the list of states that will have such bans. 

The bans restrict which items recipients of the federal food assistance program that helps 42 million Americans afford groceries can buy with their SNAP benefits.

Arkansas, Colorado, Florida, Idaho, Indiana, Iowa, Louisiana, Nebraska, Oklahoma, Texas, Utah and West Virginia already have similar incoming bans.

Members of a key CDC advisory committee, known as the Advisory Committee on Immunization Practices, met in Atlanta on Dec. 4. Maya Homan/Georgia Recorder

ATLANTA — A Centers for Disease Control and Prevention committee voted to eliminate a recommendation that all newborn babies receive a vaccine against hepatitis B, ending a policy that has been in place since 1991 to protect Americans against an incurable liver disease that can lead to cirrhosis, cancer and liver failure. 

The current three-dose series for hepatitis B includes one vaccine administered to infants within 24 hours of birth, and subsequent booster shots given one month and six months after the initial dose. The universal vaccination policy is credited with a 99% drop in serious infections among American children between 1990 and 2019.

In its updated guidelines, the agency will continue to recommend that babies born to mothers who test positive for hepatitis B receive a vaccine at birth. However, in all other cases, the decision will be left to “individual-based decision-making,” a change that experts say will lead to an increase in chronic hepatitis B infections. The new recommendation also suggests that parents delay the first dose of the vaccine until at least two months after birth.

Friday’s decision comes after an 8-3 vote from a key CDC advisory committee, known as the Advisory Committee on Immunization Practices, which is charged with setting national guidelines around which people should be vaccinated against a wide range of preventable diseases and when those vaccines should be administered. The recommendations play a key role in determining which vaccines insurance companies are willing to cover and how accessible those immunizations are to the public.

The two-day meeting included several presentations from prominent anti-vaccine activists, including Aaron Siri, a vaccine injury lawyer who has previously represented U.S. Health Secretary Robert F. Kennedy Jr. and reportedly helped him vet health officials for President Donald Trump’s administration. At least two of them — Cynthia Nevison, a climate researcher who has ties to anti-vaccine groups, and Mark Blaxill, a former consultant and author — were recently hired by the CDC.

Retsef Levi, an ACIP member and professor of operations management at the Massachusetts Institute of Technology, called the updated recommendation a “very positive change in policy,” arguing that blanket vaccine recommendations force newborns to serve as “a safety net for adults’ mistakes.”

But Dr. Cody Meissner, another member of the committee who also serves as a professor of pediatrics and medicine at Dartmouth College, argued that the vaccines play a crucial role in protecting infants from the disease, and said there was no valid scientific evidence to support the changes implemented by the panel.

“Thoughtful inquiry is always commendable,” he told the committee. “But that inquiry should not be confused with baseless skepticism, which is what I think we’re encountering here.”

Sandra Fryhofer, a doctor and liaison for the American Medical Association, also criticized the move, arguing that implementing guidelines based on the mother’s hepatitis status will leave babies vulnerable to developing the disease from other sources, such as infected relatives. According to CDC data, roughly half of people with hepatitis B do not know they are infected.

“Are we going to test every patient that has access to or touches that baby?” she asked the committee Thursday. “I mean, that’s not something that’s really doable.”

The updated recommendation for the hepatitis B vaccine mirrors COVID-19 vaccine guidelines passed by the same panel in September, which place new emphasis on the risks of immunizations, though the CDC’s own data shows that the vaccines are safe and effective for most people. 

A second vote, which passed 6-4, encourages parents to discuss using serology testing, a type of blood test that measures antibodies to gauge how well a patient’s immune system has responded to a disease, before allowing their children to receive additional doses of the hepatitis B vaccine.

The changed recommendations will not prevent doctors from administering hepatitis B vaccines to newborns, but critics say they could create additional hurdles for families and healthcare providers.

“Adding excessive or ambiguous language around shared decision-making for routine vaccines muddies the waters, creates a false sense of scientific uncertainty and places unnecessary burden on clinicians and families,” said Dr. Natasha Bagdasarian, who was representing the Association of State and Territorial Health Officials.

Children enrolled in Medicaid or the Vaccines for Children program, which provides free immunizations to children who are uninsured or underinsured, will continue to be eligible for hepatitis B vaccines at birth under the new recommendations, according to program liaisons.

Federal fallout

As with the new COVID-19 vaccine recommendations, the updated hepatitis B guidelines will not take effect until being officially signed off by the acting CDC Director, Jim O’Neill.

But amid shifting federal guidance on public health policies, a growing number of state and federal officials are developing their own policies rather than relying on the agency’s guidelines. In a Dec. 3 letter sent ahead of ACIP’s meeting, more than 30 members of Congress urged O’Neill to maintain the existing recommendations, regardless of what the advisory committee decided.

“There is no data to support delaying the first immunization to one-month, four years, or 12 years of age,” the letter states.

U.S. Sen. Bill Cassidy, a Louisiana Republican who heads the Senate Health, Education, Labor and Pensions Committee, also called for O’Neill to forgo signing the updated recommendations.

“As a liver doctor who has treated patients with hepatitis B for decades, this change to the vaccine schedule is a mistake,” he wrote in a social media post after the vote. “The hepatitis B vaccine is safe and effective. The birth dose is a recommendation, NOT a mandate.”

Cassidy, a doctor, cast the deciding vote to confirm Kennedy as health secretary on the condition that Kennedy “maintain the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices without changes.” Kennedy later backtracked on that promise, firing all 17 previous members of the committee and replacing them with a slate of hand-picked appointees, many of whom are seen as vaccine skeptics.

In a Thursday social media post, Cassidy criticized the committee for its plans to hear testimony from Siri, the vaccine injury lawyer.

“The ACIP is totally discredited,” he added. “They are not protecting children.”

Children are pictured at an Autism Speaks Light it Up Blue Autism Awareness Celebration at Chicago Children's Museum in April 2017. State Medicaid agencies are struggling to pay for applied behavior analysis, an intensive therapy for children with autism. (Photo by Daniel Boczarski/Getty Images for Autism Speaks)

State Medicaid agencies are struggling to pay for an intensive therapy for children with autism — and looming federal Medicaid cuts are likely to make the problem worse.

Parents of children and young adults who receive applied behavior analysis, or ABA, worry states’ cost-saving measures will make it harder for them to get vital services. About 5% of children ages 3 to 17 on public insurance have autism spectrum disorder, compared with 2% who have private insurance, according to a CDC survey.

Many families and autism therapists say ABA can help improve communication and social skills, sharpen memory and focus, and replace challenging behaviors with positive ones. ABA therapy can range from 10 to 40 hours per week in different settings, including home and school. That makes it expensive.

In 2014, the federal Centers for Medicare & Medicaid Services mandated that all state Medicaid programs cover comprehensive autism services for children. It did not explicitly require coverage of ABA, but by 2022, every state Medicaid program covered ABA.

In addition, more kids are getting diagnosed with autism as screenings increase. As a result, state spending on the service has skyrocketed. In Indiana, for example, Medicaid spending on ABA therapy grew from $21 million in 2017 to $611 million in 2023. The sharp increase has prompted Indiana, and other states, to take steps to control costs.

Meanwhile, federal auditors have begun examining states’ coverage of ABA services to ferret out fraud and abuse.

Mariel Fernandez, vice president of government affairs at the Council of Autism Service Providers, a nonprofit trade association, acknowledged that states are facing difficult choices.

“For such a costly and intensive service, the states need to explore how to best reimburse this benefit so that it’s sustainable and promotes quality,” said Fernandez, who is also a board-certified behavioral analyst. “Is [the rate] going to bankrupt Medicaid? Is it going to ensure that people are actually receiving the service?”

The Medicaid changes included in the One Big Beautiful Bill Act that President Donald Trump signed in July will increase the pressure: The law includes more than $900 billion in federal spending cuts over the next decade. Medicaid is funded jointly by the federal government and the states.

Meanwhile, Health and Human Services Secretary Robert F. Kennedy Jr. has described autism as a rapidly growing “epidemic” in the U.S. and has made it a major focus of his tenure. Kennedy has promoted the debunked theory that there’s a link between childhood vaccines and autism.

Curbing costs

Several states this year have considered curbing ABA costs by capping therapy hours, tightening provider enrollment rules, reducing reimbursement rates or changing patient eligibility rules. A bill in New York, for example, would establish a 680-hour annual cap on ABA services.

But nowhere has the issue been more prominent than in Indiana, where Medicaid has covered ABA therapy since 2016.

Governor’s group recommends ABA usage cap, rate changes as Medicaid costs rise

Historically, Indiana Medicaid has reimbursed ABA providers for most services at a rate of 40%, regardless of what they charged.

That “created some very strange incentives for a small portion of the provider network,” said Jason McManus, president of Indiana Providers of Effective Autism Treatment (InPEAT), which represents smaller ABA providers in Indiana and larger providers that operate in Indiana and elsewhere. “You had folks who were charging exorbitant amounts for the service.”

Beginning in 2024, Indiana lowered its reimbursement rate to about $68 per hour — and received plenty of pushback.

“That did have an impact on the provider community,” McManus said. “You had a lot of folks, smaller shops, who ended up closing their doors or consolidating with other organizations. So that was disruptive.”

And that year, the HHS inspector general issued a report which found that Indiana’s Medicaid program made at least $56 million in “improper” payments to ABA therapy providers in 2019 and 2020.

The state’s rapidly rising ABA costs and the federal audit prompted Republican Gov. Mike Braun to issue an executive order earlier this year creating a working group to examine ways to cut costs without compromising quality.

The group crafted recommendations to correct the problems identified in the federal audit and put ABA coverage on a financially sustainable path. Without changes in the state’s reimbursement policies, the group concluded, Indiana’s Medicaid spending on ABA therapy would reach a projected $825 million by 2029.

This month, Braun unveiled the group’s recommendations, which include the creation of a new ABA office to increase oversight and lower reimbursement rates, which the state has not yet detailed.

ABA allows people with autism “to obtain the highest level of independence that’s possible for them,” said McManus, who served on the working group.

“But from a state perspective, I can see how, if you’re purely just looking at the cost, you would say, ‘Wow, this is a cost that has grown over time, and if absent all other contexts, this is something we need to pay attention to, because it’s unsustainable.’”

Nebraska rate cut

In Nebraska, state officials also have been looking for ways to control spiraling ABA costs: Last year, Nebraska Medicaid paid out more than $85 million for ABA therapy, a surge from $4.6 million in 2020.

In July, the state announced that it would cut its Medicaid reimbursement rates for ABA, including a 48% cut to reimbursement for direct therapy provided by a behavior technician. That brought the rate to $74.80 per hour, down from about $144 per hour. Rates for therapy by physicians or other board-certified professionals also were reduced by about 37%.

Many providers saw the cuts coming, as the state has had the highest hourly reimbursement rate in the nation.

“It would be fiscally irresponsible of the state to maintain that,” said Leila Allen, vice president of external affairs at Lighthouse Autism Center, which has ABA therapy centers in Nebraska as well as in Illinois, Indiana, Iowa, Michigan and North Carolina.

Sam Wallach, president of Attain, an ABA therapy provider that operates in Nebraska and a dozen other states and Washington, D.C., said the service is “life-changing for children and families.” He views the ABA reduction as a “correction” that will make it feasible for Nebraska Medicaid to continue to cover it.

“The previous rates were well above what most Medicaid programs pay nationally, and while that created short-term benefits, it wasn’t realistic or sustainable,” Wallach said.

But some providers are taking issue with the way Nebraska went about those cuts.

For example, the state provided only 30 days’ notice before making the change. “There were providers that within 30 days had to tell their staff, ‘We’re so sorry. We have to cut your salary by ‘x’ percent in 30 days,’” Allen said.

Nebraska also didn’t examine how much it costs to provide ABA in the state, she said. The new rate is closer to what neighboring states, such as Iowa, pay. But therapists are few and far between in sparsely populated Nebraska, and families there often have to travel long distances to reach ABA providers.

“There was no cost survey to determine what the cost should be,” said Allen. “They didn’t take into account that you do have to pay people a little bit more to be able to work as behavior analysts in Nebraska.”

Finding ABA therapists in Nebraska is particularly difficult for families with older kids. Angela Gleason, executive secretary on the board of autism advocacy organization Arc of Nebraska, has a 13-year-old son with autism. She said many companies only serve very young children, up to age 6.

“So for families like mine, it’s then hard to even find a company that will serve his age and will provide that kind of support,” she said. To be able to afford therapy, her son Teddy has Medicaid coverage as his secondary insurance. ABA therapy helps him with socializing and speaking with his speech delay.

“He needs a lot more help throughout his day than a normal 13-year-old without autism might need,” Gleason said.

North Carolina court case

In North Carolina, the cost of covering autism services, including ABA, will total an estimated $639 million in fiscal 2026, up 425% from 2022, according to the state’s Medicaid agency. About five autism providers made up roughly 41% of the state’s increase in spending in fiscal year 2023-2024, according to the state.

Effective on Oct. 1, North Carolina Medicaid cut reimbursement rates for all kinds of health care services, arguing that state legislators had not budgeted enough money to keep up with rising costs. The reductions, which ranged from 3% to 10%, included a 10% cut to the reimbursement rate for autism services, including ABA therapy.

But the families of 21 children immediately sued the state Department of Health and Human Services to halt the move, arguing that it was discriminatory because it targeted children with disabilities.

Earlier this month, the families won a preliminary injunction temporarily halting the rate cut.

But families across the state are on edge as children with autism often see multiple providers — psychologists and speech language pathologists, for example — whose rate cuts were not paused, according to Allen, of Lighthouse Autism Center.

David Laxton, director of communications for the Autism Society of North Carolina, which is also a provider, said many providers won’t be able to absorb the rate reductions and continue operating.

“At some point, the math is not going to math,” Laxton said.

“It’s very stressful for families, because right now, there’s not an end in sight,” Laxton said. “There’s agreement that this [service] is very important, but there’s not been action to bring an end to the cuts.”

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

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Wisconsin candidates now have a path to get off the ballot besides dying, thanks to a proposal Gov. Tony Evers signed into law on Friday.

The proposal was triggered by 2024 presidential candidate Robert F. Kennedy Jr.’s failed attempt to withdraw from the ballot in a bid to boost President Donald Trump’s candidacy. The case made its way to the Wisconsin Supreme Court, which rejected Kennedy’s argument after a lower court ruled that death was the only way for nominees to drop off the ballot.

Under the measure that Evers, a Democrat, signed into law, candidates can now get off the ballot as long as they file to withdraw at least seven business days before the Wisconsin Elections Commission certifies candidates ahead of the August and November elections and pay processing fees to the Wisconsin Elections Commission. The measure doesn’t apply to the February and April elections.

Many county clerks had opposed an earlier version of the legislation because the originally proposed deadline to drop out would have disrupted tight timelines to prepare, print and send off ballots on time. That deadline would have allowed candidates to get off the ballot any time before the election commission certified candidates’ names.

To address those concerns, Rep. David Steffen, the Republican author of the measure, amended the proposal to require candidates to let the commission know at least seven business days ahead of time. The law also would charge anybody impersonating a candidate to get off the ballot with a felony.

The measure passed the Assembly with a voice vote. It passed the Senate 19-14, with just two Democratic votes in favor. 

Steffen called the new law a win for Wisconsin voters, adding in a statement that it will “reduce unnecessary voter confusion.”

Clerks say they can adjust to ballot law

The new law won’t change operations much, said Wood County Clerk Trent Miner, a Republican in a county of about 74,000. Miner’s office programs and prepares the county’s ballots, which he said would make readjusting the ballots easier.

La Crosse County Clerk Ginny Dankmeyer, a Democrat, said a candidate dropping out at the last minute would still lead to extra hours of work since ballots are generally ready to be printed by then. But Dankmeyer added that it’s still doable and won’t stress her out. She said the new deadline is far better than the originally proposed one.

The Wisconsin law prohibiting withdrawal in cases besides death stood out nationwide as unusually strict. The state used to allow nominees to drop off the ballot if they declined to run, but it changed the policy in 1977 to the one that was active until Evers signed the new law last week.

Many other states allow nominees to drop off the ballot between 60 and 85 days before an election. Some states require polling places to have notices clarifying candidates’ withdrawal if they drop out after ballots are already printed.

Kennedy’s attempt to get off the ballot last year shocked clerks, who had already printed their ballots when his case was moving through the courts. 

His lawyers requested that clerks cover up his name on the ballot with stickers, a proposal that clerks said could lead to tabulator jams and disenfranchised voters. Kennedy still received 17,740 votes, or about 0.5% of the vote. Trump won the state by a little less than a percentage point.

Votebeat is a nonprofit news organization reporting on voting access and election administration across the U.S. Sign up for Votebeat Wisconsin’s free newsletter here.

Alexander Shur is a reporter for Votebeat based in Wisconsin. Contact Shur at ashur@votebeat.org.

Wisconsin candidates have path off the ballot besides death under new law is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.