The Sexual Violence Prevention Association (SVPA) joined by FORGE Forward, interACT, and the Trans Empowerment Project, are urging HHS to rescind two proposed rules for Medicare and Medicaid that would increase sexual violence against children, particularly trans, intersex, and gender nonconforming youth.
The US Department of Health and Human Services (HHS) has introduced two proposed rules that, if adopted, will increase state-sanctioned sexual violence against transgender and intersex youth by restricting access to healthcare and expanding government control over children’s bodies. On February 17th, the SVPA submitted two public comments to HHS and the Centers for Medicare and Medicaid Services (CMS) opposing the two proposed rules. The rules, “Prohibition on Federal Medicaid and Children’s Health Insurance Program Funding for Sex-Rejecting Procedures Furnished to Children” (CMS-2451-P) and “Hospital Condition of Participation: Prohibiting Sex-Rejecting Procedures for Children” (CMS-3481-P), use different regulatory mechanisms but share the same harmful objective: denying care to vulnerable children.
The first rule would prohibit federal funding under Medicaid and the Children’s Health Insurance Program (CHIP) from being used for “sex-rejecting procedures” on minors. The second would prevent hospitals that offer gender affirming care from participating in Medicare and Medicaid. Both rules clearly communicate that nonconsensual and irreversible medical interventions on intersex infants and children are still permitted. Together, these rules attempt to strip transgender youth of their access to healthcare while simultaneously allowing healthcare providers to perform dangerous and unnecessary procedures on intersex youth. This contradiction exposes the underlying harm embedded in both proposals.
By framing gender diversity as a disorder requiring verification, the rules promote invasive examinations of children’s bodies in order to determine eligibility for care. Forced genital inspections and coercive medical practices are a form of state-sanctioned sexual violence. Further, the exception allowing irreversible surgeries on intersex children, including infants, who cannot consent, is another form of state-sanctioned sexual violence.
“These provisions reveal a dangerous inconsistency: consensual, often reversible care for transgender adolescents would be prohibited, while nonconsensual, irreversible procedures on intersex children would be permitted,” said Katie Knick, Research Director for the SVPA. “How can we explain to our youth that our government doesn’t care about them?”
Both rules utilize an oppressive tactic called SORVO– Systemic Oppression, Reverse Victim and Offender- in which oppressors reframe themselves as protectors while portraying vulnerable communities as threats. The rules repeatedly characterize consensual gender-affirming care for transgender children as “mutilation” while characterizing nonconsensual forced surgeries against intersex youth as “protection.” They invoke child-protection narratives to justify federal control over children’s bodies, in a textbook case of SORVO.
The language and structure of these proposed rules are not designed to safeguard youth, but to systemically control access to healthcare for transgender and intersex children. By claiming they are protecting children, the rules employ SORVO to justify discrimination and expand state-sanctioned sexual violence.
SVPA submitted public comments calling for the withdrawal of both rules in their entirety. We were joined by three impactful organizations dedicated to the protection of LGBTQ+ youth- FORGE Forward, interACT, and the Trans Empowerment Project.
Together, we urge HHS and CMS to abandon these harmful proposals. Instead, they should engage with sexual violence prevention experts, gender-diverse and intersex communities, and medical professionals.
“Protecting children requires evidence-based care, consent, and policies that reduce sexual violence. These rules do the opposite,” said Omny Miranda Martone, Founder and CEO of the SVPA. “If enacted, they will make sexual violence a legally mandated practice for hospitals and healthcare providers, harming millions of trans, gender nonconforming, and intersex children across the country.”
