Trump’s HHS stripped Medicaid from transgender kids’ evidence-based care to punish their families.
Here is what this looks like at the kitchen table. You have a kid. The kid is thirteen or fifteen or seventeen, and the kid is transgender, and you have known this for years, and the family has done what families are supposed to do: found a doctor, gotten a diagnosis, started the puberty blockers or the hormones or the speech therapy that every major medical organization says is medically necessary and lifesaving. The bill is large. The bill is always large. Medicaid is the reason the family can pay it. Forty-one-point-four percent of New Mexico lives on Medicaid or CHIP. Sixty-one percent of the state’s children are insured through those two programs. For the family of a transgender teenager in Albuquerque or Santa Fe or Las Cruces, Medicaid coverage of gender-affirming care is not an abstract policy debate. It is the difference between treatment and no treatment.
Now do the math that the rule makes a family do. A year of leuprolide, the puberty blocker most commonly prescribed, runs twelve thousand to thirty-six thousand dollars out of pocket. Hormone therapy and the counseling every major medical organization recommends alongside it add another five thousand to fifteen thousand. The arithmetic the federal government handed these families on August 13 is a recurring bill of roughly seventeen thousand to fifty-one thousand dollars a year, on top of the rent and the premiums and the student loans and the daycare for the younger sibling. In Albuquerque, the median rent for a two-bedroom apartment is now about eighteen thousand dollars a year. The choice the rule constructs is the choice between the kid’s medicine and the roof over their head. This is not a budget argument. The cost of gender-affirming care for transgender adolescents is a sliver of state Medicaid spending. The Williams Institute at UCLA estimates there are 4,800 transgender teenagers between thirteen and seventeen in New Mexico today. The number of minors accessing any specific gender-affirming Medicaid service is smaller still. Stripping the coverage does not balance any state’s budget. It targets a population. It is the policy equivalent of finding a specific child and taking away their medicine to make a political point.
I have sat at this kitchen table before. I sat at it when the SAVE plan repayment schedule changed three times in eighteen months and the family’s student-loan payment jumped from ninety-two dollars to five hundred and fifty. I sat at it when the expanded Child Tax Credit lapsed and four million children went back over the poverty line. I sat at it when the ACA subsidy cliff let premiums double on the family’s marketplace plan at the end of 2025. Each time the federal government renegotiated a program downward, the arithmetic at this kitchen table got harder. Each time, the families I know did the same thing — moved the same numbers between the same two columns and tried to find a configuration that worked. None of them worked. The configurations got smaller. The Trump administration has now added gender-affirming care to that list of programs the federal government has decided it can withdraw from a category of children without consequence.
New Mexico has decided to be the country these families need. The state’s Health Care Authority is planning to continue covering gender-affirming care for minors using state funds. The legislature built the Health Care Affordability Fund in 2021 for exactly this kind of moment — when Washington fails to protect working families and the most vulnerable among us. The state is now the floor of last resort. New Jersey passed a shield law the same week. The pattern is the structural story: the federal government has decided Medicaid is for almost everyone except the kids a particular political coalition has chosen to punish, and the states that disagree are absorbing the cost. Families are relocating across state lines so their kid can see a doctor, leaving jobs and houses and grandmothers and parishes so their teenager can access puberty blockers. New Mexico has the second-highest percentage of residents enrolled in Medicaid or CHIP in the country. The state has decided to be the floor. The federal government has decided to be the opposite.
There is a Swift song on The Tortured Poets Department called “I Can Do It With a Broken Heart” in which the narrator describes performing nightly — dance rehearsals, stage shows, the whole apparatus of competence — while the underlying collapse is happening. The chorus is “I’m miserable, and I’m making it look so good.” That song is the closest text in the Swift catalog to a direct labor-conditions song, and the song’s working mother is not the pop star. The song’s working mother is a content strategist in New Mexico who has just been told that the puberty blockers her teenager needs are no longer covered by Medicaid and who will go to work on Monday and do her job and pick up her kid on Tuesday and run the numbers at eleven at night on Wednesday and find a way, because there is no other way to find. Anne Helen Petersen wrote in Can’t Even that burnout “will not be cured by a productivity app or a face mask.” It will also not be cured by a state Medicaid program that withdraws from a category of children because a political coalition decided to make an example of them.
The math says what the math says. Forty-one-point-four percent of New Mexico’s population is on Medicaid or CHIP. Sixty-one percent of the state’s children. The Trump administration has finalized a rule that ends federal funding for the gender-affirming care of those children. The rule goes into effect October 13. New Mexico is paying. New Jersey is shielding. The federal government has drawn a line around a category of sick children and walked away. You are on your own, kid.