The Report on Medicare Compliance quoted McGuireWoods partner Greg Fosheim in an Aug. 17, 2026, article regarding a final regulation by the Centers for Medicare & Medicaid Services (CMS) about gender-affirming care for minors.
CMS announced on Aug. 13, 2026, that Medicaid and the Children’s Health Insurance Program (CHIP) would no longer pay for a minor’s gender-affirming care, but it also would not stand in the way of such care if someone else foots the bill, according to the article.
Fosheim pointed out that the CMS rule forbids the use of state Medicaid money for gender-affirming care, which means a state is prohibited from picking up the tab unless it has a different form of insurance unrelated to Medicaid and CHIP.
“Suppose Illinois receives 50% matching funds from CMS,” the article continued, quoting Fosheim: “Medicaid couldn’t cover the Illinois portion of SRPs even if Illinois doesn’t submit the claim to CMS.”
“The final rule requires states to revise their state Medicaid plans to the extent they include these prohibited services as a covered service,” Fosheim added.
He noted that CMS will supply federal funds for procedures to treat precocious puberty, congenital defect, disease or physical injury, as well as for behavioral healthcare for gender dysphoria.
Fosheim told the Report on Medicare Compliance that the rule creates challenges for state Medicaid plans that include gender-affirming care and providers that bill for it, especially regarding billing compliance. Providers must be “very meticulous with their claims processing and not try to circumvent these prohibitions by misrepresenting what the care was for and trying to submit claims to Medicaid using incorrect codes,” Fosheim said.