A note from Dr. Shawn Giammattei

Amid the pre-holiday hustle and bustle — while many families were focused on school breaks, travel, and simply catching their breath — important decisions were quietly moving forward in Washington.

On December 17, federal agencies advanced proposals that could affect access to gender-affirming care for transgender and gender-diverse youth. I know how familiar this feels for many families: decisions made quickly, with little public attention, that negatively impact the care our children rely on.

Right now we are in a comment period and I’m asking you to comment because I’ve spent decades sitting with parents and caregivers who are doing everything they can — thoughtfully, lovingly — to support their children. I’ve seen how affirming, evidence-based care strengthens families and saves lives. I’ve also seen the fear that emerges when that care is threatened by politics rather than medical expertise.

Right now, we have a real opportunity to be heard.

These proposals are not laws.
They are open for public comment — and that means your voice matters.

What’s Happening — and Why This Moment Matters

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), has released two proposed rules that could limit access to gender-affirming care for minors by changing how federal health funding can be used.

These proposals could affect:

• Hospitals that receive Medicare or Medicaid funding
• Medicaid and CHIP coverage for gender-affirming care for minors

They do not make care illegal. Instead, they attempt to restrict access through funding rules — and because they are proposals, public input can influence what happens next.

• ⏳ 60-day public comment period
• 🗣 Public voices are reviewed and responded to
• 🛠 Final rules are not set yet

This reinforces agency and possibility, not fear.

What You Can Do Today

Submitting a public comment is one of the most direct ways to show up for trans and gender-diverse youth. You do not need policy expertise — your lived experience and values are enough. If you do have expertise, please share that as well.

Take action here:

👉 Comment on the Medicaid & CHIP proposal
https://www.regulations.gov/document/CMS-2025-1823-0001

👉 Comment on the hospital participation proposal
https://www.regulations.gov/document/CMS-2025-1822-0001

Click “Submit a Comment.” A few thoughtful sentences truly matter.

How to Comment Safely

Public comments become part of the federal record. You are always in control of what you share.

You may:

• Comment without including personal contact information
• Avoid names or identifying details
• Focus on values, impact, and care rather than private information

Your safety and comfort matter.

A Final Word

Our community has faced moments like this before — often quietly, often unexpectedly. And each time, it has been the steady presence of families, caregivers, and allies that has shaped what comes next.

Taking a few minutes to submit a comment is an act of care. It’s a way of saying: our children matter, our families matter, and our voices belong in these decisions.

Thank you for being here. Thank you for showing up.

With care,
Dr. Shawn Giammattei, PhD
Founder & CEO, TransFamily Alliance &
Gender Health Training Institute