Trump's 2026 financial budget proposal revokes health insurance for federal transgender employees

The Trump administration's fiscal year 2026 budget proposal includes a provision that could significantly impact the access to gender affirming care for federal employees and service members. The proposal aims to end the insurance program that covers gender-affirming care for both federal employees and their dependents.

The Office of Personnel Management (OPM) has been instrumental in regulating FEHBP coverage for gender affirming care. In 2016, OPM first allowed insurance carriers to include services or drugs to treat gender dysphoria in their coverage. However, in February, OPM instructed insurance carriers to cease covering gender affirming care for FEHBP beneficiaries under the age of 19 by 2026.

The Department of Health and Human Services also decided to end the insurance program for federal employees that covers gender-affirming care in the fiscal year 2026 budget proposal. This decision is expected to affect adults as well, as the proposal does not provide coverage for gender affirming care treatments for adults.

The provision to end insurance coverage for gender affirming care is among a list of government-wide provisions in a 1,200-page appendix. The budget proposal states that no funds can be used for insurance plans to cover the cost of surgical procedures, puberty blockers, or hormone therapy for gender affirming care.

The Trump administration's actions targeting trans individuals' access to healthcare have been ongoing since January. More than 4,000 current service members have been ousted from the U.S. military since January due to the Trump administration's hostility towards trans public servants. The House Republicans made a late change to their budget reconciliation package a week ago, expanding the ban on Medicaid or CHIP funds going toward pediatric and adult gender affirming care.

The Trump administration's actions have a significant impact on trans individuals' access to healthcare, both in the U.S. military and the federal workforce. In 2024, OPM stipulated that no FEHBP insurance carrier "may categorically exclude from coverage services related to gender affirming care." However, the recent developments in the budget proposal suggest a reversal of this stance.

The full budget proposal was published on Friday, providing a clear picture of the administration's stance on gender affirming care. It remains to be seen how these changes will be received and implemented in the coming years.