AGG Healthcare attorneys Andrew Tsui, Gabe Scannapieco, and Aditya Krishnaswamy co-authored an article for Law360 analyzing a new Centers for Medicare & Medicaid final rule restricting federal Medicaid funding for pediatric gender-affirming care, alongside the U.S. Department of Justice (“DOJ”) parallel enforcement campaign against hospitals and providers furnishing that care.
Andrew, Gabe, and Aditya explained that the final rule, effective October 13, 2026, prohibits federal financial participation under Medicaid and CHIP for “sex-rejecting procedures” furnished to minors, with only a six-month tapering period for beneficiaries already receiving cross-sex hormone therapy.
“Stakeholders should account for the final rule and the DOJ’s enforcement activity in operational planning, including decisions concerning coverage, claims processing, prior authorization, documentation, and federal-program exposure,” the attorneys wrote.
The attorneys also detailed the DOJ’s use of False Claims Act theories and administrative subpoenas, including three hospital settlements and the Ninth Circuit’s QueerDoc decision, which strengthened the DOJ’s ability to use subpoenas to obtain provider and patient records even as courts continue to narrow their scope on other grounds.
“The coming litigation will test not only the final rule, but also the broader use of federal funding and enforcement leverage to influence medical care traditionally regulated by states.”
To view the full article, please click here. For more information about AGG’s Gender-Affirming Care Investigations Response Team, please click here.
- Andrew Tsui
Partner
- Gabriel H. Scannapieco
Partner
- Aditya Krishnaswamy
Associate
