Four New Hampshire families are asking a federal judge to intervene over a new federal rule affecting Medicaid coverage for their transgender children's medical care. One of the plaintiffs, a Hillsborough County teenager identified by the pseudonym Kylie Koe, is starting puberty and was prescribed puberty blockers — treatment the family says the rule is already preventing her from receiving. The rule took effect October 13.
Families Sue Over Rule Cutting Off Coverage
The families sued the Trump administration over a rule affecting Medicaid funding for transgender youth seeking gender-affirming care, according to the Concord Monitor. The rule bars Medicaid and CHIP benefits from paying for gender dysphoria treatment and medication for transgender youth, and it directly prevents Kylie from receiving the puberty blocker treatment her doctor prescribed, per the newspaper's reporting. The case, Goe v. U.S. Department of Health and Human Services, was filed in the U.S. District Court for the District of New Hampshire, according to the complaint hosted by the Georgetown Law Litigation Tracker, which lists the four adolescent plaintiffs as Grace Goe, Kylie Koe, Logan Loe and Maya Moe, all transgender youth and Medicaid beneficiaries.
The lawsuit argues that ending Medicaid coverage will devastate families unable to pay privately and describes the harm as imminent, concrete and irreparable, per the Concord Monitor.
Attorneys Clash Before Judge McAuliffe
A GLAD Law attorney asked the federal district court to issue a preliminary injunction preserving the families' children's medical care while the case continues, and a hearing took place Friday before Judge Steven J. McAuliffe, the Concord Monitor reports. GLAD senior staff attorney Chris Erchull represented the families and argued that the rule departed substantially from past practice and that the Centers for Medicare and Medicaid Services should not be the one determining which categories of care go uncovered. “These young people won’t be in the same position that they’re in now,” Erchull said, according to the newspaper's account of the hearing.
Erchull also accused the administration of acting unlawfully and claiming authority it does not have, and he said federal government interference is a major factor affecting young people, per the Concord Monitor's reporting. Stephen Tagert represented the federal government and countered that the administration followed the necessary processes to finalize the rule. Tagert argued the issue concerns the type of procedure at stake rather than the specific diagnosis, and he said the federal government deemed the procedures to have irreversible consequences that are not beneficial for young people.
A Supreme Court Precedent Takes Center Stage
Tagert cited Armstrong v. Exceptional Child Center, a 2015 U.S. Supreme Court case, telling the court the decision gives CMS authority to decide what Medicaid can and cannot cover, according to the Concord Monitor. In that case, the Supreme Court held that the Supremacy Clause does not confer a private right of action, meaning Medicaid providers cannot sue for an injunction requiring compliance with a key Medicaid Act provision, according to the Legal Information Institute's record of the Supreme Court opinion. That case had concerned Idaho's Medicaid reimbursement rates for providers of habilitation services, not coverage for patients themselves.
The rule itself traces back to an August CMS filing. According to the Georgetown complaint, the agency published a final rule categorically prohibiting federal financial participation for the specified treatments for all Medicaid enrollees under 18 and CHIP enrollees under 19, with the ban taking effect October 13. The complaint also notes that the federal government provides between 50% and approximately 83% of state Medicaid expenditures, a funding structure the plaintiffs say makes the rule's reach especially consequential for low-income families.
New Hampshire's Own Ban Still Stands
Erchull said the outcome of this case will not affect New Hampshire's separate 2025 law banning gender-affirming care for new patients under age 18, per the Concord Monitor, though he noted the plaintiffs are covered by that law's continuing care clause. GLAD Law said it will continue advocacy for transgender youth across New Hampshire regardless of how the federal case unfolds.
The families are represented by GLAD Law, the National Center for LGBTQ Rights, the ACLU of New Hampshire and Robinson & Cole, according to the complaint. The ACLU of New Hampshire said the rule cuts off federal Medicaid and CHIP funding for medications and other treatment for gender dysphoria in young people, including care a patient's own doctor has deemed medically necessary. The litigation has moved on an expedited track since plaintiffs filed their preliminary-injunction motion October 1: the government responded October 15, and plaintiffs filed a reply October 22, according to the Georgetown Law Litigation Tracker, which also shows the case combines Administrative Procedure Act claims with a Fifth Amendment equal-protection challenge.
No Timeline for a Ruling
Erchull said Judge McAuliffe seemed to understand the decision's significance for the four families, but he acknowledged the injunction decision has no known timeline, telling the Concord Monitor that judges have sometimes taken several weeks to issue rulings in similar matters. He said he hopes McAuliffe recognizes the urgency the families face, adding that full resolution of the underlying case could take years regardless of what happens with the injunction request.
