STAT+: Medicaid transgender care rule sets precedent that could restrict coverage of other drugs

The Centers for Medicare and Medicaid Services issued a final rule this month barring the use of federal Medicaid and CHIP funding to pay for pediatric gender-affirming medications and surgery. The rule, set to go into effect Oct. 13, is the latest development in the administration's campaign to halt transgender health care for young people.

Medicaid experts say the rule sets a precedent that could be used to deny coverage of drugs and other services beyond gender-affirming care. This could upend the general expectation that Medicaid covers the vast majority of prescription medication, as the program typically must cover most FDA-approved outpatient drugs for medically accepted indications, provided drug companies agree to pay significant rebates to participate.