The Department of Health and Human Services issued a rule Thursday that will ban hospitals from performing so-called gender-affirming procedures on children as a condition of Medicare and Medicaid funding.

Through the Centers for Medicare & Medicaid Services (CMS), HHS will “ensure that the U.S. government will not be in business with organizations that intentionally or unintentionally inflict permanent harm on children,” the department said. The HHS guidance comes after the department released a report in May that concluded transgender procedures for children pose underreported “medical dangers.”

HHS Secretary Robert F. Kennedy, Jr. reiterated those findings in a declaration signed this week, which would declare practitioners who perform sex-reassignment procedures on children out of compliance with medical standards.

Sex-rejecting procedures are “neither safe nor effective as a treatment modality for gender dysphoria in minors,” an HHS official said, and medical professionals should “refuse to provide puberty blockers, cross sex hormones, or surgical interventions to children.”

Thursday’s announcement follows a bevy of proposed efforts by the Trump administration to restrict federal funding for sex-reassignment procedures.

National Review was the first to report in July that HHS would begin the rule-making process to stop the federal government from funding sex-rejecting procedures through Medicaid and the Children’s Health Insurance Program (CHIP), after President Donald Trump issued an Executive Order in January ordering HHS to review existing literature on best practices for gender dysphoria healthcare. The order also directed agencies to end the chemical and surgical mutilation of children.

HHS also announced Thursday that the U.S. Food and Drug Administration would send warning letters to twelve manufacturers of breast binders for illegally marketing the products to children for the use of treating gender dysphoria. Breast binders, which along with TransTape, nipple guards, and tucking underwear are commonly branded as “gender-affirming products,” are medical devices that should be used “for purposes such as assistance in recovery from cancer-related mastectomy,” HHS said in a brief.

Hospitals often collaborate with children’s organizations or public schools to issue products such as chest binders to minors. In Seattle, National Review recently reported, Seattle Children’s Hospital provided Seattle Public Schools with chest binders and tucking underwear, to be placed in lockers for students as part of a “Community Health Locker Project.”

A slew of children’s hospitals — most notably the Children’s Hospital Los Angeles, which operates one of the oldest gender clinics in the country — have been scaling back access to puberty blockers, hormone therapy, and surgeries for transgender-identifying minors since Trump took office. Twenty-seven states have restricted Medicaid coverage of trans-affirming procedures for children.

HHS also proposed an effort to revise the Biden administration’s classification of gender dysphoria as a disability. Former President Joe Biden’s HHS administrators extended the definition of “disability” under section 504 of the Rehabilitation Act of 1973 to include gender dysphoria. Biden’s administration argued that any restrictions preventing or limiting “qualified individuals’ access to care due to their gender dysphoria . . . may violate section 504.”

Trump’s HHS would reverse Biden’s definition, and clarify that “gender dysphoria” doesn’t fall under the umbrella of a “disability” protected by section 504.

“We’re taking this action to ensure that HHS funding recipients comply with the best reading of the plain language of 504,” an HHS official said. “By suggesting that gender dysphoria may qualify as a disability under section 504, the Biden administration created confusion about the scope of HHS funding recipients’ obligations to those individuals under the disability rights requirements of section 504.”

“The proposed rule would reassure recipients of HHS funding that their programs or activities that prevent, limit, or exclude sex-rejecting procedures would not violate section 504.”