The new $269 billion state budget signed into law by New York Governor Kathy Hochul failed to allocate any funding for programs designed to expand access to gender-affirming care, drawing criticism from advocacy groups that had spent months urging state leaders to intervene as access to care faces increasing challenges nationwide.
The omission comes as transgender advocacy groups and civil liberties organizations have warned that actions taken by the federal government and hospitals around the country have made it more difficult for some patients to obtain gender-affirming medical services.
Advocates had pushed Albany to establish a dedicated Gender-Affirming Care Access Program, a state-funded initiative intended to help outpatient providers absorb patients who lost access to care after hospitals scaled back or discontinued certain services. Supporters argued that the program would create an alternative pathway for care at a time when some healthcare systems have reduced offerings amid legal and political uncertainty.
Despite those efforts, the final state budget included no funding for the proposal.
Civil liberties advocates expressed frustration with the outcome.
“As the Trump administration continues to pose an existential threat to the transgender community, we are profoundly disappointed that the FY2027 New York State budget invests zero state dollars to support access to the health care many transgender, gender non-conforming, nonbinary, and intersex people rely on to live in their bodies with dignity and health — a complete failure to meet the moment,” said Allie Bohm, NYCLU senior policy counsel.
Bohm also called on state officials to pursue additional legislative protections.
“We urge our lawmakers and the Governor to take urgent action to restore New York’s reputation as a beacon for gender-affirming care access by codifying New York’s insurance coverage requirement for gender-affirming care, strengthening our health care anti-discrimination laws, enacting robust health privacy protections both for electronic health records and for consumer health data, and advancing hospital transparency.”
At the center of the debate was a proposal that would have directed state funds to healthcare providers continuing to offer gender-affirming care including clinics that may have lost federal support for maintaining those services.
Supporters argued the measure would help stabilize access to care and ensure providers could continue serving patients displaced from hospital-based programs.
“Creating and funding the Gender-Affirming Care Access Program would send a clear message: New York believes that access to essential healthcare is a matter of dignity, freedom and justice,” wrote Assemblymember Jessica González-Rojas in an April opinion piece urging lawmakers to include the proposal in the budget.
Advocates pointed to developments in other states as examples of alternative approaches. In Massachusetts, Governor Maura Healey signed legislation creating a Gender-Affirming Care Trust Fund in 2025. The measure established a funding mechanism intended to support transgender healthcare if federal funding streams are interrupted.
The debate in New York unfolded against a backdrop of changing healthcare policies nationwide. According to a STAT News analysis cited by advocates, more than 40 hospitals across the country have paused or discontinued some form of gender-affirming care for transgender youth following executive actions issued by President Donald Trump following his return to office in 2025.
Advocacy groups contend many hospitals acted preemptively because of concerns about losing Medicare and Medicaid funding even before any federal rule authorizing such penalties had taken effect.
In New York, opponents of those hospital decisions argue state law already prohibits discrimination against transgender patients. Attorney General Letitia James previously warned healthcare providers that denying care to transgender patients while offering comparable services to others could violate New York anti-discrimination statutes.
Nevertheless, critics say some hospitals, including NYU Langone, have reduced or ended certain programs despite those warnings.
Supporters of the proposed state fund argued that direct financial assistance or expanded services through public healthcare systems could provide patients with an additional avenue to obtain treatment while disputes over enforcement of existing laws continue.
The budget debate also highlighted concerns about actions taken at the local level.
New York City Mayor Zohran Mamdani previously campaigned on a pledge to invest $65 million in gender-affirming care through public hospitals and community clinics. However, that funding did not appear in the city’s preliminary budget proposal and questions remain about whether those funds have been allocated.
Advocates have also criticized city officials for not expanding access through the public hospital system or taking stronger action against hospitals they believe are failing to comply with state law.
Writing in The Nation, journalist Sophie Hurwitz argued that progress has fallen short of campaign promises, stating that despite Mamdani’s commitments and his participation in protests opposing cuts to transgender healthcare services, “many of his promises to the trans community have yet to become reality.”
With the state budget now finalized, advocacy groups are expected to continue pressing lawmakers and executive officials for additional funding and policy changes aimed at protecting access to gender-affirming care in New York.
But thus far, their efforts have yielded no results.
