The U.S. Department of Health and Human Services on Thursday unveiled a series of regulatory actions designed to block access to gender-affirming care for minors, building on broader Trump administration restrictions on transgender Americans.

The sweeping proposals — the most significant moves this administration has taken to restrict the use of puberty blockers, hormone therapy and surgical interventions for transgender children — include cutting off federal Medicaid and Medicare funding from hospitals that provide gender-affirming care to children and prohibiting federal Medicaid dollars from being used to fund such procedures.

“This is not medicine; it is malpractice,” Health Secretary Robert F. Kennedy Jr. said of gender-affirming procedures on children in a news conference on Thursday. “Sex-rejecting procedures rob children of their futures.”

Thursday’s announcements would imperil access in nearly two dozen states where drug treatments and surgical procedures remain legal and funded by Medicaid, which includes federal and state dollars.

Among those states is Maryland, which has become a destination for transgender health care, including for youths, with some hospitals and other providers offering services to adults and youths.

State health leaders say they continue to “wholeheartedly support” the transgender community.

“Gender-affirming coverage under Medicaid remains unchanged,” Dr. Meena Seshamani, Maryland’s health secretary, said in a statement. “The Maryland Department of Health will continue to monitor the federal government’s proposed actions in this area, and work to minimize the negative impacts to the community, continue to meet the goals of the Maryland Trans Health Equity Act, and protect Medicaid services for the broader population.”

The act went into effect last year and requires the state Medicaid program to cover a range of services to transgender patients. That would stop if the proposed federal regulations become official.

One of the providers, the University of Maryland Medical Center, said in a statement, “We are aware of the proposed regulatory actions and will review any implications they may have on how care is delivered.”

The Johns Hopkins Hospital didn’t immediately respond to a request for comment, and Chase Brexton Health Care declined to comment.

The proposals run counter to the recommendations of most major U.S. medical organizations. And advocates for transgender children strongly disputed the administration’s claims about gender-affirming care and said Thursday’s moves would put lives at risk.

“The multitude of efforts we are seeing from federal legislators to strip transgender and nonbinary youth of the health care they need is deeply troubling,” said Rodrigo Heng-Lehtinen of The Trevor Project, a nonprofit suicide prevention organization for LBGTQ+ youth.

Medicaid programs in slightly less than half of states cover gender-affirming care. At least 27 states have adopted laws restricting or banning the care. The Supreme Court’s recent decision upholding Tennessee’s ban means most other state laws are likely to remain in place.

The proposals announced by Kennedy and his deputies are not final or legally binding. The federal government must go through a lengthy rulemaking process, including periods of public comment and document rewrites, before the restrictions become permanent. They are also likely to face legal challenges.

But the proposed rules will likely further intimidate health care providers from offering gender-affirming care to children, and many hospitals have ceased such care in anticipation of federal action.

Some patients will still be able to receive care via private clinics specializing in transgender medicine, which often don’t participate in Medicare and Medicaid.

But nearly all U.S. hospitals participate in the Medicare and Medicaid programs, the federal government’s largest health plans that cover seniors, people with disabilities and low-income Americans. Losing access to those payments would imperil most U.S. hospitals and medical providers.

The same funding restrictions would apply to a smaller health program, the Children’s Health Insurance Program, when it comes to care for people under the age of 19, according to a federal notice posted Thursday morning.

“This sets a very dangerous precedent for all areas of health care, if the government can cherry-pick one area of medicine to use to withhold necessary funding from entire groups of people,” said Dr. Scott Leibowitz, a child and adolescent psychiatrist and board member for the World Professional Association for Transgender Health.

WPATH developed standards of care for transgender patients globally, including creating guardrails backed by medical evidence and noting the importance of including patients and their families in decision-making.

Kennedy also announced Thursday that the HHS Office of Civil Rights will propose a rule excluding gender dysphoria from the definition of a disability. Gender dysphoria is a formal medical diagnosis that describes the distress felt when someone’s gender expression does not match their gender identity.

In a related move, the Food and Drug Administration issued warning letters to a dozen companies that market chest-binding vests and other equipment used by people with gender dysphoria. Manufacturers include GenderBender LLC of Carson, California, and TomboyX of Seattle. The FDA letters state that chest binders can be legally marketed only for FDA-approved medical uses, such as recovery after mastectomy surgery.

Dr. Mehmet Oz, the administrator of the Centers for Medicare and Medicaid Services, on Thursday called transgender treatments “a Band-Aid on a much deeper pathology,” and suggested children with gender dysphoria are “confused, lost and need help.”

Polling shows many Americans agree with the administration’s view of the issue. An Associated Press-NORC Center for Public Affairs Research survey conducted in May found that about half of U.S. adults approved of how President Donald Trump was handling transgender issues.

Chloe Cole, a conservative activist known for speaking about her gender-transition reversal, spoke at the news conference to express appreciation. She said cries for help from her and others in her situation, “have finally been heard.”

But the approach contradicts the recommendations of most major U.S. medical organizations, including the American Medical Association, which has urged states not to restrict care for gender dysphoria. The American Academy of Pediatrics called on HHS to reverse course Thursday, saying “children and families will bear the consequences.”

“These rules are a baseless intrusion into the patient-physician relationship. Patients, their families, and their physicians—not politicians or government officials —should be the ones to make decisions together about what care is best for them,” said Dr. Susan Kressly, AAP president. “The government’s actions today make that task harder, if not impossible, for families of gender-diverse and transgender youth.”

The announcements build on a wave of actions Trump, his administration and Republicans in Congress have taken to target the rights of transgender people.

On his first day in office, Trump signed an executive order that declared the federal government would recognize only two immutable sexes: male and female. He also has signed orders aimed at cutting off federal support for gender transitions for people under 19 and barring transgender athletes from participating in girls’ and women’s sports.

On Wednesday, a bill that would open transgender health care providers to prison time if they treat people under the 18 passed the U.S. House and headed to the Senate. Another bill under consideration in the House on Thursday aims to ban Medicaid coverage for gender-affirming care for children.

Young people who persistently identify as a gender that differs from their sex assigned at birth are first evaluated by a team of professionals. Some may try a social transition, involving changing a hairstyle or pronouns. Some may later also receive hormone-blocking drugs that delay puberty, followed by testosterone or estrogen to bring about the desired physical changes in patients. Surgery is rare for minors.