Kylie Koe is 13 and starting puberty. Her doctor prescribed puberty blockers, but a federal rule that took effect Oct. 13 says Medicaid, her only health insurance, can’t pay for them.
Her family and three others are asking U.S. District Judge Steven J. McAuliffe in Concord to keep their daughters’ care going while they sue the Trump administration. The families filed suit Oct. 1. Kylie Koe is a pseudonym. So are Grace Goe, Logan Loe and Maya Moe, the other girls in the case, who are 11, 15 and 15, the complaint shows.
Trump’s Medicaid Rule on Gender-Affirming Care Took Effect Oct. 13
The rule from the Centers for Medicare & Medicaid Services stops federal Medicaid money from paying for puberty blockers, hormones or surgery for gender dysphoria in anyone under 18. CHIP money is cut off for those under 19, according to HHS. States can still pay for these services with state-only funds outside the federally funded programs. The families are challenging the loss of coverage for medication, not seeking access to surgery.
The rule has a narrow transition provision: federal funding can continue for up to six months to taper hormone therapy that patients were already receiving when it took effect. That provision does not cover puberty blockers, KFF explains. Counseling and psychotherapy remain covered.
“Today, we are ending federal taxpayer funding for sex-rejecting procedures on children,” HHS Secretary Robert F. Kennedy Jr. said Aug. 11 in a CMS release. “Sex-rejecting procedures” is the administration’s phrase for gender-affirming care.
KFF estimates about 130,000 young trans people on Medicaid or CHIP live in states that don’t restrict their care.
“For some young transgender teenagers, the inability to access medical care means, in a way, that you’re forced to develop secondary sex characteristics associated with being male,” Chris Erchull, a senior staff attorney at GLBTQ Legal Advocates & Defenders, told NHPR when the families sued Oct. 1. “That would be extremely harmful to their perception of their self, and it would force others to recognize them in a different way.”
Dr. Frances B. Lim-Liberty, a pediatric endocrinologist at Dartmouth Health, spoke for herself when she told the Boston Globe, “We’re really looking at a forced detransition.”
“These are people who don’t have another option available to them,” Erchull told the Globe. “They have nowhere else to turn.”
The Families and DOJ Disagree Over Who Can Keep Receiving Care
New Hampshire already bars blockers and hormones for new patients under 18. Gov. Kelly Ayotte signed that law in 2025, and it lets patients who started before Jan. 1, 2026, keep going, NHPR reported at the time. The families argue that all four girls qualify because their courses of treatment began before that date. Whether the clause protects an ongoing course of care or only a medication already prescribed is a central dispute in the filings.
The Justice Department reads it differently. Trial attorney J. Stephen Tagert’s Oct. 15 brief argues that only Logan and Maya could get any relief at all. “Grace Goe and Kylie Koe have never taken puberty blockers and Logan Loe has never taken hormones,” it says.
The brief also points to an Oct. 1 letter New Hampshire sent CMS Administrator Dr. Mehmet Oz. In it, the state said it “does not anticipate any changes to the State Plan” because of the rule. The families shot back in an Oct. 22 filing that the letter “identifies no Plaintiff, denies no claim, and says nothing about ending the State’s coverage of this treatment.”
On Oct. 5, McAuliffe denied relief to the extent the families were seeking a temporary restraining order, finding they hadn’t supported that request with an affidavit showing immediate and irreparable injury, his order shows. That did not resolve the merits of the lawsuit or the separate motion for a preliminary injunction.
A Separate Challenge From the States
A coalition of state attorneys general co-led by Massachusetts sued over the same rule Sept. 2. U.S. District Judge William G. Young has that case in Boston.
“It sets a very dangerous precedent,” Shannon Minter, legal director of the National Center for LGBTQ Rights, told NHPR. “So even if people don’t particularly care about transgender young people or these families, everyone should care about setting a precedent that could be used against any disfavored group by any future administration.”
The families were shocked when the coverage was pulled, Minter said. “The thought that your child is receiving care that they need and it’s benefiting them, helping them, and that you’re going to have that taken away is obviously like hard to think of anything that would be more distressing to parents,” he said.
