On August 15, 2025, the Trump administration took a decisive—and controversial—step that will affect millions of Americans: gender-affirming care will no longer be covered for federal workers under the government’s largest health insurance programs starting in 2026. The announcement, delivered in a letter from the Office of Personnel Management (OPM) to insurance carriers, signals a sweeping change set to impact federal employees, postal workers, and their families across the country.
The OPM’s letter, signed by Healthcare and Insurance division director D. Shane Stevens, leaves little room for ambiguity. "Chemical and surgical modification of an individual's sex traits through medical interventions (to include 'gender transition' services) will no longer be covered under the FEHB or PSHB programs ... regardless of age," the notice stated, as reported by Bloomberg Law and The Advocate. This policy applies to both the Federal Employees Health Benefits (FEHB) program, which serves over eight million federal workers, and the Postal Service Health Benefits (PSHB) program, which insures an additional two million postal employees.
For years, the federal government’s stance on gender-affirming care has been a patchwork. Previously, coverage for gender-affirming procedures or hormone treatments was not provided for individuals under 19, while those over 19 could receive coverage at the insurer’s discretion. Now, with this new directive, the exclusion is comprehensive—regardless of a person’s age or circumstances.
The policy specifically bans insurance coverage for any "chemical and surgical modification of an individual's sex traits." That means hormone therapies, surgeries, and related interventions for the purpose of gender transition will be excluded from federal health plans. However, the OPM clarified that hormone therapies remain covered when prescribed for other medical reasons—such as in vitro fertilization (IVF), endometriosis, fibroids, cancer treatment, or tumor growth prevention. The denial applies only to transgender individuals seeking these treatments for gender dysphoria.
There is, however, a narrow exception: individuals who are already "mid-treatment within a surgical and/or hormonal regimen for diagnosed gender dysphoria" may continue care, with eligibility determined by healthcare providers on a case-by-case basis. This carve-out, though, offers limited solace to those who have not yet begun or are considering medical transition in the future.
While the policy is sweeping, it does not eliminate all forms of support for federal employees experiencing gender dysphoria. Counseling services remain covered, provided they are delivered by licensed mental health professionals. The OPM’s guidance even specifies that "counseling services must be provided by a licensed mental health provider and may include those who provide faith-based counseling." This inclusion of faith-based counselors is notable, reflecting ongoing debates about the role of religion in mental health care and the diverse needs of those seeking support.
Insurance carriers are also instructed not to list or recognize providers for the purposes of chemical and surgical modification of sex traits in their provider directories, effectively removing any official pathways for federal employees to seek gender-affirming medical care through their government-sponsored insurance.
The numbers at stake are significant. According to the Williams Institute, an estimated 14,000 federal employees are transgender. The ripple effects of the policy, however, extend beyond these individuals to their spouses, dependents, and adult children—potentially affecting tens of thousands of people who rely on federal health benefits for comprehensive care.
Reaction to the policy was swift and sharply divided. Civil rights and LGBTQ+ advocacy organizations condemned the move as discriminatory and illegal. Omar Gonzalez-Pagan, counsel and health-care strategist at Lambda Legal, blasted the policy in a statement to Bloomberg Law: "This discriminatory policy denying medical care to government employees and their dependents is not only cruel—it is illegal. The federal government cannot simply strip away essential healthcare coverage from transgender employees while providing comprehensive medical care to all other federal workers."
Kelley Robinson, president of the Human Rights Campaign, echoed these concerns in a statement to The Advocate: "Everyone should have access to the health care they need – full stop. But this latest move by the Trump administration escalates the far-right’s war on trans people’s medically necessary health care – care that is backed by every major medical organization in the country and should be between providers and their patients." Robinson went on to warn, "Instituting blanket bans on people’s care drags us back decades and does not just impact federal employees, but plunges their spouses, dependents, and adult children into crisis too. First, this administration claims to know better than parents and cuts off younger folks’ access to care. Now they’re making their true aim clear as day: eliminating access to health care for transgender people of all ages. We’re going to fight this every single way we can."
Major medical organizations are united in their opposition to the ban. The American Medical Association, the American Psychiatric Association, the American Academy of Pediatrics, the American Academy of Child & Adolescent Psychiatry, the World Medical Association, and the World Health Organization all agree that gender-affirming care is evidence-based and medically necessary—not just for adults, but for minors as well. These organizations stress that such care can be life-saving and is best determined by patients in consultation with their healthcare providers, not by blanket government policy.
Legal experts anticipate that the policy will face robust challenges in court. The exclusion appears to contradict anti-discrimination protections enshrined in Title VII of the 1964 Civil Rights Act and Section 1557 of the Affordable Care Act, both of which prohibit discrimination on the basis of sex. As Bloomberg Law notes, these statutes have been interpreted by courts in recent years to include protections for transgender individuals, setting the stage for potential legal battles over the administration’s authority to restrict coverage in this way.
The Trump administration’s move comes amid a broader national debate over transgender rights and access to healthcare. In recent years, several states have enacted laws restricting gender-affirming care for minors, sparking lawsuits and heated political arguments. The federal government’s decision to implement a ban for its own workforce—one of the nation’s largest—marks a significant escalation in this ongoing struggle.
Supporters of the policy argue that it aligns with the administration’s commitment to enforcing laws based on biological sex, as outlined in President Trump’s January executive order. They contend that gender-affirming procedures are not a legitimate use of taxpayer-funded insurance and that the government has a responsibility to set boundaries on what constitutes essential medical care. Some also welcome the continued coverage of counseling services, particularly those provided by faith-based counselors, as a balanced approach to supporting employees with gender dysphoria.
Opponents, on the other hand, see the policy as part of a broader campaign to roll back civil rights protections for LGBTQ+ Americans. They argue that denying coverage for gender-affirming care not only undermines the health and well-being of transgender individuals but also sets a dangerous precedent for government interference in the doctor-patient relationship.
As the 2026 implementation date approaches, federal workers, advocacy groups, and legal experts are bracing for what promises to be a contentious fight—one that could have far-reaching implications for the future of healthcare access and civil rights in the United States. For now, the message from the federal government is clear: gender-affirming care will no longer be part of the benefits package for millions of its employees, setting the stage for a new chapter in the nation’s ongoing debate over equality, healthcare, and the role of government.
