Kira Rambles

On January 28th, Donald Trump signed an executive order banning gender-affirming care in the US for patients under 19. In the weeks since, Colorado hospitals like Children’s, Denver Health, and UC Health have stopped scheduling patients for this care, even though it reduces suicide rates, citing their need for federal funding, notwithstanding the fact Colorado’s AG says hospitals are no longer at risk of losing that funding for providing those services.  

But that federal funding is a lot more complicated than just complying with the order. In messages to medical providers, Children’s has maintained they had to stop providing hormone blockers and hormone replacement therapy (Children’s did not offer patients gender affirming surgery before the order) to continue to be able to serve low-income Medicaid patients. Medicaid is a state program operated through federal guidelines to provide healthcare access for primarily low-income families, children, pregnant people, and people with disabilities. It relies on matching funding from both states and the federal government, and with 650,000 children in Colorado on Medicaid, it’s easy to see why Children’s would panic at the thought of losing compensation for seeing those patients. But Medicaid funding has been in danger for years, and a new budget resolution from Washington is forecasting its serious reduction or end.

Last week, tweets from people with access to a new budget resolution have reported a potential $880 million cut to Medicaid funding–roughly its entire budget. And while the resolution does not explicitly mention that figure or Medicaid, it does call for a $2 trillion reduction in permanent programs with federal funding, meaning Medicaid, which makes up 10% of current federal spending, will be on the cutting block. 

Maybe that’s why the Children’s Hospital Association ramped up publishing educational materials about the importance of Medicaid for kids last month. Or maybe it’s because Medicaid was already in danger. In May 2023, the federal government ended a COVID-19 policy extending coverage without proof of eligibility. In the aftermath, 550,000 Coloradans lost Medicaid coverage, mostly due to application errors, not their income. And Medicaid’s state funding is in jeopardy in Colorado too, meaning medical providers that see Medicaid patients are seeing their reimbursement rates for their care shrink with inflation–if they’re compensated at all. When people lose Medicaid, like the 550,000 Coloradans after May 2023, they often end up uninsured, and hospitals and providers don’t receive any compensation for their care. 

The Children’s Hospital Association website asserts “Medicaid funding ensures children’s hospitals are able to be there for all children,” and that they “believe that no child should lose health insurance because of changes to the Affordable Care Act (ACA) or Medicaid,” but Children’s Colorado’s reaction to the executive order on gender-affirming care does not reflect that. On the contrary, it is a move to protect the hospital’s bottom line by preserving current Medicaid funding that’s likely to shrink or disappear in the near future with federal budget changes the state will not be able to compensate for. It’s a losing game, and, in the meantime, Colorado hospitals, including Children’s, are denying trans kids life-saving care.