Bug was two weeks from his first dose of testosterone when the letter arrived.

His family had done everything that was supposed to work. They left Texas in 2024, resettled in western Massachusetts, and enrolled their children in a private school near the Berkshires. When Bug, then in sixth grade, told his mother he was a boy, she felt confident the state’s laws would protect his access to care.

She was wrong. In February, Baystate Health — the largest hospital system in the region — informed families it would no longer prescribe gender-affirming medications to minors. The decision came not because any court ordered it, or because any federal rule had taken effect. It came because the hospital chose not to wait.

The Legal Shield That Didn’t Hold

Massachusetts built its defenses carefully. A 2022 shield law protects doctors and nurses who provide gender-affirming care; legislators strengthened those protections in 2025. State law requires commercial insurers to cover the treatment. And when Health and Human Services Secretary Robert F. Kennedy Jr. issued a declaration in December 2025 calling such care unsafe and threatening to strip Medicare and Medicaid funding from providers, Massachusetts joined 19 other states in suing.

In March, a federal judge in Oregon ruled that Kennedy had overstepped his legal authority, according to the New York Times. Twenty-one Democratic-led states had argued the declaration unlawfully interfered with states’ power to regulate medical practice within their borders.

None of that stopped Baystate. The hospital said in a statement that its decision reflected the risk to “hundreds of millions of dollars in government reimbursement,” noting that nearly 70 percent of its patients rely on Medicaid and Medicare.

Baystate is not alone. A STAT News analysis identified more than 40 hospitals nationwide that have paused or ended some form of gender-affirming care for minors since January 2025, including institutions in California, Illinois, New York, and Colorado — all states challenging the administration in court.

Pre-Compliance as Risk Management

The proposed CMS rules tying Medicare and Medicaid participation to a ban on pediatric gender-affirming care have not taken effect. The executive order faces multiple legal challenges. Yet institutions are preemptively calculating that the cost of resistance exceeds the cost of compliance.

Carmel Shachar, director of the Health Law and Policy Clinic at Harvard Law School, told STAT News that hospitals likely “don’t want to be made the example to enforce the rule on day one.” HHS general counsel Mike Stuart posted on X: “We will not stop until every single child is protected from the destruction of the integrity of God’s chosen human body.”

Shachar warned the precedent could extend beyond transgender care. If HHS successfully links Medicare and Medicaid conditions to specific medical practices, other politicized services — including mRNA vaccines and contraception — could follow.

The American Academy of Pediatrics, which supports gender-affirming treatment for minors, told NPR that every pediatrician it approached was too afraid of retaliation to comment publicly.

Families Caught in the Gap

For parents like J, the institutional retreat feels like a betrayal compounded by the state promises that failed to prevent it.

“All of a sudden it just felt like the floor had fallen out,” J told NPR. “Maybe this is naive, but I didn’t think that would happen in Massachusetts, and certainly not preemptively.”

Another mother, identified only as L, told NPR she had not yet told her 14-year-old transgender daughter that Baystate was ending care. Before starting puberty blockers and estrogen, the girl had been severely depressed and battling suicidal thoughts. After beginning treatment, her mood and grades improved markedly. L worried the news could send her back into crisis.

“It’s a scary time to be 14 and trans right now,” L said.

Some families have found alternatives. Bug was referred to TransHealth, a private specialty clinic in Northampton that is less dependent on federal reimbursement than most hospitals, thanks to large private donations. CEO Jo Erwin told NPR the clinic expects to absorb more than 200 former Baystate patients, plus dozens from Boston’s Fenway Health, which also ended hormone therapy for trans youth.

But Erwin acknowledged the fragility of that safety net. “When you see something like that go down,” she said, “people get scared that it’s ultimately going to happen to everyone.”

Bug’s mother shares that fear. “Now we’re dependent on privately-funded places, and that doesn’t feel like very firm ground to be standing on,” she said. She sometimes wonders whether the family should have kept going north — past Massachusetts, all the way to Canada.

Sources