7. The proposed rule nevertheless asserts that these guidelines would preempt state laws, placing a direct target on the “shield laws” enacted by states like California, Minnesota, and New York. The text is explicit in its intent to override state sovereignty.

6. The government attempts to get around this by stating that gender affirming care is not part of “the practice of medicine.” In a section dedicated to this anticipated challenge, the new rule states:

5. This rule violates multiple U.S. statutes and constitutional limits on federal authority. Most notably, Section 1801 of the Social Security Act explicitly bars the federal government from using Medicaid regulations to exercise direct supervision or control over the practice of medicine.

4.The new rule contains no exceptions for patients already receiving care, meaning transgender youth who have remained in treatment even under some red-state bans would immediately see that care cut off. For many, this would amount to forced medical detransition.

The government acknowledges this.

3. Rather than directly banning Medicaid reimbursement for transgender care, the rule would bar any hospital that accepts Medicaid funding from providing gender-affirming care for trans youth at all, regardless of whether that care is paid for by Medicaid.

2. On Thursday, the Trump administration’s HHS, under Secretary Robert F. Kennedy Jr., released a new rule that uses Medicaid "conditions of participation" to strip funding from hospitals that treat trans youth—the most aggressive attack on trans healthcare in U.S. history.

The rule is seen here: