ACCMA Comments on Proposed Federal Regulations Restricting Gender-Affirming care February 27, 2026 Advocacy, Hot Topics The Alameda-Contra Costa Medical Association (ACCMA) has submitted formal comments opposing two proposed federal regulations that would restrict access to certain pharmaceutical and surgical gender-affirming care services for children and adolescents. One proposal would prohibit hospitals from participating in the Medicare and Medicaid programs if they provide specified puberty-blocking medications, cross-sex hormones, and gender-affirming surgical procedures to patients under age 19. The second proposal would prohibit federal matching funds under Medicaid and CHIP for those same pharmaceutical and surgical interventions when furnished to individuals under age 19. ACCMA’s comments primarily focused on the following areas: Government interference in clinical decision-making: Both proposed rules use federal participation requirements or funding conditions to categorically prohibit specific medical treatments, substituting federal policy judgments for individualized physician-led clinical decision-making. Misuse of regulatory and funding mechanisms: The Conditions of Participation framework and Medicaid/CHIP funding structure are traditionally intended to ensure safety, quality, and program integrity, not to dictate the permissibility of particular medical interventions absent demonstrated systemic failures. Evidence and patient outcomes: Peer-reviewed studies indicate that gender-affirming care is associated with improved mental health outcomes for transgender adolescents, while surgical interventions in minors are rare and subject to rigorous safeguards. Categorical prohibitions do not reflect the current evidence base. Precedent and professional autonomy: Allowing federal authorities to prohibit specific medical services through participation or funding restrictions sets a broader precedent that could extend political interference into other areas of medical practice, undermining the physician–patient relationship and professional autonomy. We recognize that ACCMA members hold a range of personal and professional views on gender-affirming care, and the Association does not presume unanimity on these issues. What unites us is a shared and longstanding professional principle that the practice of medicine should be governed by clinical judgment, scientific evidence, and the physician–patient relationship – not by ideological or political mandates imposed through federal financing policy. The public comment period for both proposals is open through February 17, 2026. Members who wish to review the proposed regulations or submit comments in their individual capacity consistent with their own professional judgment may do so at: • Medicare Conditions of Participation proposal: https://www.federalregister.gov/documents/2025/12/19/2025-23465/medicare-and-medicaid-programs-hospital-condition-of-participation-prohibiting-sex-rejecting • Medicaid/CHIP funding proposal: https://www.federalregister.gov/documents/2025/12/19/2025-23464/medicaid-program-prohibition-on-federal-medicaid-and-childrens-health-insurance-program-funding-for Questions or concerns may be directed to accma@accma.org.