Good news out of Richmond. Starting October 13, 2026, Virginia's Medicaid program will stop paying for puberty blockers, opposite-sex hormones and surgeries on children.
What Virginia is doing
The Virginia Department of Medical Assistance Services (DMAS) told providers in a bulletin that for dates of service on or after October 13, it "will no longer cover gender dysphoria services for Medicaid members under the age of 18, and CHIP members under the age of 19."
- Children already on these drugs as of October 13 can be tapered off over up to six months. Providers must get a service authorization for the taper.
- Mental health coverage stays in place without changes, DMAS says.
- No new starts, no puberty blockers and no surgeries will be paid for by Virginia Medicaid for minors after the cutoff.
Unlike Oregon and California, which are reaching into state budgets to keep paying, Virginia is not backfilling the lost federal money.
Why it's happening
DMAS says it is acting "in accordance with a new federal final rule." That rule, CMS-2451-F, was issued by the Centers for Medicare & Medicaid Services and published August 13. It bars federal Medicaid money for "sex-rejecting procedures" on anyone under 18, and federal CHIP money for anyone under 19. It defines those procedures as "any pharmaceutical or surgical intervention that attempts to align a child's physical appearance or body with an asserted identity that differs from the child's sex."
"Today, we are ending federal taxpayer funding for sex-rejecting procedures on children," HHS Secretary Robert F. Kennedy Jr. said when the rule was announced. "These interventions carry serious risks and can cause irreversible harm."
CMS pointed to an HHS evidence review, the UK's Cass Review, and restrictions in other countries and U.S. states. States may still pay with their own money if they choose.
The lawsuit
Virginia's own attorney general is fighting the rule. On September 2, the attorneys general of 20 states and the District of Columbia, plus Pennsylvania's governor, sued HHS and CMS in federal court in Massachusetts, asking a judge to strike the rule down in their states. Virginia is one of the plaintiffs. As of today, no court has blocked the rule, and it takes effect tomorrow.
So for now, Virginia's Medicaid agency is following the rule, and Virginia children on Medicaid will be off these drugs within six months.