Trump Administration Issues Policy Changes on Provision of Gender-Affirming Care

On January 28, 2025, President Trump issued Executive Order 14187 (Protecting Children from Chemical and Surgical Mutilation), directing federal agencies to cut off federal funding and support for gender-affirming care for people under age 19, including puberty blockers, hormone therapy, and gender-affirming surgery.

On December 18, 2025, health officials from the Trump administration announced several additional policy changes that, if finalized, will have the effect of essentially banning gender-affirming care for transgender young people, even in states where it remains legal.

One rule would prohibit Medicaid from covering any medical care provided to transgender patients younger than age 18 and prohibit reimbursement though CHIP (Children’s Health Insurance Program) for gender-affirming care for patients under 19.

Additionally, all Medicare and Medicaid funding would be blocked for any services at hospitals that provide pediatric gender-affirming care. This means that hospitals and doctors that perform gender-affirming care on minors will have to forgo federal Medicare and Medicaid funding under the new proposed rules. Virtually every hospital in the country relies on this funding, so the rule would have a wide-ranging impact and could likely make gender-affirming care inaccessible nationwide.

The proposed rules would exclude gender dysphoria not caused by physical impairment from civil-rights health care protections, reducing legal safeguards against discrimination in medical care.

This multi-pronged plan from DHS is part of the Trump Administration’s efforts to limit gender-affirming care, and if finalized, could have a profound impact on care delivery for transgender and gender non-conforming individuals.

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ODP Updates the MAAC on Paid Relative Caregiving & Travel Limitations

By Tim Sohosky • May 29, 2026

On Thursday, May 28, the Office of Developmental Programs (ODP) provided an update to the Medical Assistance Advisory Committee (MAAC) regarding current policies and upcoming regulatory changes following a recent Commonwealth Court decision. On February 17, 2026, the PA Commonwealth Court issued a decision in Dunkelberger v. Department of Human Services that determined that ODP’s limitations on provider model services (specifically the 40/60-hour caps and 90-day travel maximums) were null and void. The decision was based on process rather than policy validity; the Court found that these limitations were not properly promulgated as regulations in accordance with the Commonwealth Documents Law and Regulatory Review Act. To maintain a balanced approach between flexibility and oversight, ODP is moving forward with the following actions: Regulatory Amendments: ODP will amend regulations to establish formal authority for setting service delivery limits that support individual welfare and program integrity. Self-Directed Model Agreements: ODP has already modified agreements for self-directed models to clarify limits on overtime, combined relative service provision, and travel restrictions. Travel Restrictions: Due to the inability to monitor services effectively over long distances, service provision will now be limited to Pennsylvania and contiguous states. Waiver Changes: ODP will seek modifications through the amendment process to the Consolidated, P/FDS, Community Living, and Adult Autism Waivers to include: New requirements for agencies providing IHCS and Companion services to disclose a DSP's relationship to participants; and Strengthened programmatic oversight and integrity measures. Life Sharing Alternative: For participants requiring more than 60 hours of paid care from a relative, the Life Sharing (24/7) service model remains the recommended alternative. ODP anticipates a public comment period for these proposed waiver changes beginning in January 2027.

Two men with intellectual disabilities working happily on a tablet.

Shapiro Administration's Strategic Investments in ID/A Community Lead to Highest Number of Pennsylvanians Ever Served in HCBS

By Tim Sohosky • May 28, 2026

Press Release from DHS : Published May 27, 2026

ODP Provides Updates to PBC 2026/27 Residential Pay-for-Performance

By Cathy Barrick • May 28, 2026

The Office of Developmental Programs (ODP) has shared ODPANN 26-039 . The purpose of this communication is to provide updated details about the Residential Performance-Based Contracting (PBC) Pay-for-Performance (P4P) initiatives for Fiscal Year 2026/27. Updates are provided in red . Please review the announcement for more details. Visit here to access the Pay for Performance (P4P): Residential Rural Capacity Expansion Plan template .