Somewhere in Connecticut right now, a kid is raising their hand in math class, trying out for the varsity soccer team, or arguing with their parents about their bedtime. Their parents are doing what parents do; they’re showing up at their soccer games, helping them with their homework, and staying up too late reading about whether a recent cough is just a cough.
Navigating their kid’s healthcare is a huge burden, but parents ultimately trust their child’s doctor, and they expect that when they walk into a hospital, the care their child will receive is the best evidence-based care possible and that their child’s needs will be met.
Two proposed federal regulations written in Washington, D.C. are about to upend this reality.
Two proposed rules from the Centers for Medicare & Medicaid Services interject federal politics directly into the medical choices of Connecticut’s youth, their families, and their providers. The Hospital Conditions of Participation Rule would bar hospitals that participate in Medicare/Medicaid from providing gender-affirming clinical care to patients under 18, and the Medicaid and Chip Funding Prohibition Rule would prohibit the use of all federal Medicaid and CHIP funding for such care for anyone under 19.
Together, these rules would result in federal policy overriding the judgement of doctors, parents, and young people, replacing individualized medical decision-making with a federal gutting of access to gender-affirming care. The federal overreach into people’s individual medical choices should, and has, offended a wide range of people across Connecticut.
Under federal law, when agencies like CMS propose new rules like those mentioned above, the agency must solicit and respond to public comments before the rules go into effect. The Out Accountability Project and Equality Connecticut gathered and submitted comments from concerned Connecticut residents in February. These comments include words from concerned youth, family members, friends, teachers, teammates, and doctors. We at the Global Health Justice Partnership joined this effort by submitting our own comments on the proposed rules. The comments contain over 100 stories describing firsthand accounts of the medical necessity of care and the risks people face when access to it is limited.
We are writing this op-ed to bring attention to the ways that stories and viewpoints raised in the comments affirm that the people of Connecticut care about protecting individual medical choices and medically necessary care, especially in the wake of Yale New Haven Health and Connecticut Children’s Medical Center, ending gender-affirming medical treatment last summer. Although data is hard to find, it appears from reports that around 1,100 youth lost access to clinical care because of these decisions. We are writing to make clear that the people of Connecticut want to continue protecting the doctors, nurses, and staff who still provide care, the youth that rely on this care, and families and friends who want to support these young people.
To be clear, gender-affirming care encompasses much more than just clinical care; the WHO defines GAC as a range of “social, psychological, behavioral, and medical interventions” which are “designed to support and affirm an individual’s gender identity.” As reflected in the public comments, parents, teachers, and community members emphasize that care is rooted in acceptance, education, and belonging. Adolescents are affirmed in their identities in classrooms, in homes, and in communities. Clinical services are only one piece of a much broader system of support that allows young people to feel seen, safe, and valued.
In the comments, the proposed rules are perceived by doctors, parents, grandparents, teachers, ministers, and neighbors as an assault on science, a source of misinformation, a rejection of medical consensus, and discrimination that will further increase the informational, educational, school-policy, resource, and referral obstacles already recorded in Connecticut.
Families emphasize the logical incoherence of permitting the same procedures to other youth, including cisgender kids with precocious puberty or kids with intersex characteristics, and prohibiting them to transgender youth. They see this differential treatment as an act of discrimination targeting their children. Furthermore, families report that federal rhetoric portrays gender-affirming care as an experimental or harmful intervention when, in reality, gender-affirming care is a well-established, coordinated, process that is determined by parents, youth, and providers. This misinformation leads parents and children to fear losing care that they depend on.
Parents and grandparents point to the fact that the major medical organizations have made gender-affirming care medically necessary, but the proposed regulations ignore this medical consensus and introduce government intervention in the process of making personal, family and clinical decisions. On the state level, the legal system of Connecticut is in line with this agreement by providing insurance coverage mandates and civil rights guidance, but the regulations pose the threat of withholding federal funds, which sends a chilling effect, contradicting the principles of the state to adhere to the best, evolving world of science rather than politics.
These policies are an affront to our identity as people of Connecticut, a state that is committed to fairness, inclusion and evidence-based care. In every corner of the state, including individual families, local schools and neighborhoods, and Connecticut’s broader policy landscape, these proposed rules are seen as a political intrusion that puts children’s lives at risk. To end this discriminatory attack on gender-affirming care, residents are calling on the key federal agencies to trust good science, dismiss misinformation, respect medical consensus, and end this discriminatory attack.
To be sure, Connecticut has not been perfect in fulfilling its promise of equitably distributing health services under its nondiscrimination principles. But it is precisely in moments like this that the state must recommit to those promises and stand firmly by its people.
As seen in the comments, our systems, communities, and neighbors care deeply about protecting care, and Connecticut cannot leave our youth and families to fight on their own. Connecticut has several laws protecting trans youth from gender discrimination, robust shield laws, and a successful lawsuit against the Kennedy Declaration signed on by Attorney General William Tong. Connecticut solidified itself as a leader in protecting its youth through these actions, but the radical change by the federal government is disrupting the status quo. Despite Connecticut’s current frameworks, the federal government continues to take away evidence-based care and infringe upon conversations that should remain between a clinician, a parent, and a child. It is Connecticut’s responsibility to restore itself as a haven for trans youth across the country.
Young people are not political symbols; they are whole individuals shaped by the communities around them. Whether we like it or not, healthcare—both as science and policy—will always be entangled in politics. The question is not whether it belongs there, but how we respond.
Connecticut must choose to act and has a good framework to act on: we have support in our anti-discrimination legislation and in our healthcare laws. The state must stand by its commitments by mobilizing across a range of resources and actors to protect and expand the full spectrum of gender-affirming care. This is the only way to ensure that every young person within its borders is treated with dignity.
Alice Miller is Co-Director of the Global Health Justice Partnership of Yale Law School and Yale School of Public Health/New Haven. Marie-Fatima Hyacinthe, PhD is a post-doctoral fellow at Global Health Justice Partnership of Yale Law School and Yale School of Public Health.
