Department of Health and Human Services (HHS) / Centers for Medicare & Medicaid Services (CMS) / Congress

45 CFR Part 92 (Section 1557 of the ACA – reinterpretations that narrow gender identity protections) CMS policies under 42 CFR Part 430 and Part 438 (state Medicaid waivers and managed care rules allowing condition-specific exclusions) HHS/OCR guidance permitting religious or ideological non-compliance with nondiscrimination obligations

—OPTIONAL--

Notice of Proposed Rulemaking

State and Insurer Exemptions from Medically Appropriate Care Coverage

Rescind the patchwork of regulatory exemptions that allow third parties to override evidence-based medical decisions — especially where benefits are denied or restricted based on non-medical criteria.

U.S. Department of Health and Human Services 200 Independence Avenue, SW Washington, DC 20201

(301) 492-4305, (410) 786-1524, (410) 786-8437

Insurers and some state Medicaid programs have carved out benefit exclusions based on diagnosis or identity labels, not treatment efficacy — limiting provider discretion and creating unequal access to care.

This rescission will: • Reinforce the doctor-patient relationship as the foundation of care • Prevent non-clinical actors from denying medically necessary treatment • Promote consistency, privacy, and personal responsibility in healthcare

Public and private healthcare plans shall not exclude coverage for physician-recommended care based on identity, diagnostic category, or political preference. Medical necessity determinations shall remain between provider and patient.

Robert F. Kennedy Jr.

Secretary of Health and Human Services