Hospices have grown increasingly concerned that evolving federal policy regarding LGBTQ+ populations may have a range of negative impacts on end-of-life outcomes and access.

A host of regulatory evolutions have taken place under the Trump administration related to transgender rights and gender-affirming policies.

The potential challenges of the current regulatory landscape should not dictate how and where any individual dies, according to California-based YoloCares CEO Craig Dresang. Hospice providers need a firm understanding of the changes to federal laws and how they impact care delivery and operations, Dresang stated.

“The law is the law, and decency is still defined by showing respect for other people,” Dresang told Hospice News in an email. “The fickleness of policy pushers and lawmakers should hold zero sway over the way health professionals integrate dignity, respect and compassion into their clinical practice. Executive actions and orders should have no bearing on how legitimate health care providers extend care to their patients.”

Regulatory moves in the midst

The most recent regulatory changes came on Tuesday during LGBTQ Pride Month. Observed across the United States in June, the month is dedicated to celebrating lesbian, gay, bisexual, asexual, intersex, transgender and queer culture and community. This week the Substance Abuse and Mental Health Services Administration (SAMHSA) announced that it will soon sunset The 988 National Suicide & Crisis Lifeline’s LGBTQ+ Youth Specialized Services program.

The suicide and crisis program allowed youths under 25 years old to access specialized support via phone, text or online chat. Access to skilled crisis counselors will still be available, but the crisis lifeline will ”no longer silo” LGBTQ+ youth services as of July 17, SAMHSA stated in the announcement.

Operated by seven centers that make up the LGBTQ+ Youth Subnetwork, the program began in 2022 under the nonprofit The Trevor Project. The crisis lifeline has helped more than 1.3 million LGBTQ+ young individuals to date. More than $33 million federal funds have been spent to support the subnetworks, according to SAMHSA.

The current regulatory climate has worsened fear and mistrust among younger and older LGTBQ+ generations alike, said Wayman Scott, associate director of diversity, equity, inclusion and community relations at Gilchrist Hospice, part of Maryland-based Gilchrist Cares.

Younger generations have grown up watching a history of prejudice, bias and fear prevent goal-concordant care delivery among LGBTQ+ populations, but health care providers have strived toward greater inclusivity in more recent decades, Scott indicated. A key driver has been stronger integration of gender-affirming care approaches, he stated.

“It’s one thing to have a policy and another thing to give resources and information to staff that they can use in their practices to make people feel comfortable, safe and seen,” Scott told Hospice News. “It’s being transparent first, even with your own preferred pronouns. That can help people feel invited and welcomed.”

The recent news builds upon funding and budget concerns outlined in the Trump administration’s One Big Beautiful Bill Act, which recently passed in the House and is in Senate review. The bill includes a budget reconciliation process of tax reductions to the tune of $4.5 million in the next decade and also included provisions that prohibit federal funding support for gender-transitioning procedures in Medicaid and the Children’s Health Insurance Program (CHIP). Hospice and palliative care providers have voiced concerns that the proposed cuts could negatively affect person-centered care innovation and access.

The budget proposal and other executive orders coming down the pipeline thus far this year are top of mind for underserved LGBTQ+ aging populations, said Aaron Tax, managing director of government affairs and policy advocacy at SAGE. The organization provides advocacy and services for LGBTQ+ elders.

“I think we are still waiting to see if and how regulations will change pursuant to these executive orders,” Tax told Hospice News in an email. “The ‘Big Beautiful Bill’ … would bar essential health care for all trans people, their health care would be at risk should the legislation move forward. These executive orders contain intentionally misleading and derogatory language about trans people.”

Another regulatory change occurred in January when the White House issued an executive order calling on federal agencies to use new definitions of sexual and gender identity. It sought to end the use of taxpayer dollars to promote “gender ideology” accepted among medical communities that “eradicated the biological reality of sex,” according to language in the executive order. Among the stipulations was to define sex as an individual’s “immutable biological classification as either male or female.”

Limitations of the executive order do not account for the nearly 2% of individuals, or 5.6 million people, born with both genitalia annually who are intersex, as reported by the Hudson Institute of Medical Research.

“There is a lot to unpack here,” Dresang told Hospice News. “At some point, these [intersex] individuals will identify with a gender … and often it is not until later in life. The current [presidential] administration wants every issue to be black or white, male or female, and that does not reflect reality. If they take issue with the gray areas, or unclear areas, of human existence, then they need to take it up with their maker and not the American people.”

Impacts on end-of-life decisions

Several federal agencies have taken action since the executive order related to sexual and gender identity.

The U.S. Centers for Medicare & Medicaid Services’ (CMS) 2026 proposed rule aimed to prevent coverage of gender-affirming care through health insurance plans under the Affordable Care Act marketplace. Meanwhile, the U.S. Centers for Disease Control and Prevention (CDC) has removed lessons supporting safe school environments for transgender and nonbinary students. The U.S. Department of Defense (DOD) has also issued guidance that active-duty transgender military service members had until June 6 to decide between voluntary or involuntary separation from their roles.

The regulatory changes have upended federal funding, cancellation of studies and stymied progress on efforts toward sexual orientation and gender identity-inclusive data collection, according to Tax. Veteran affairs programs have also begun to phase out health care benefits for transgender individuals, Tax indicated.

“While the president has the power to implement some of these [executive orders (EOs)], the most important point to understand is that EOs themselves are merely policy statements,” Tax said. “The laws are still the law and regulations are still valid until they are undone. People and organizations should not engage in anticipatory obedience.”

The regulatory moves have raised feelings of mistrust, fear and anxiety among LGBTQ+ adults. Roughly 71% of lesbian, gay, bisexual, transgender and queer Americans anticipated negative impacts from the Trump administration’s policies in a survey from the Pew Research Center.

The legislative clawbacks come at a time when older LGBTQ+ adults are facing greater health disparities compared to other populations. LGBTQ+ seniors are at increased risk for poorer physical and mental health outcomes, more emergency room visits and higher rates of depression, anxiety, loneliness and suicide, research published in the journal Generations found. These individuals often lack traditional family infrastructures and caregiver support, which can impede access to home-based end-of-life support.

Important for hospice providers to bear in mind is that internal data collection on patients’ gender and sexual preferences is still a significant part of delivering person-centered care, according to Scott.

“Collecting data on gender identity for patients is still simply collecting data. We’re not breaking any laws,” Scott told Hospice News. “It’s knowing how people can be referred to and the pronouns that are meaningful to them so that we as providers can know the physical and emotional needs of patients.”

Hospice care delivery grew out of the Civil Rights Movement and AIDS epidemic, during times when workers overcame biases, fears and embraced support for dying patients, according to Dresang. The goal of alleviating suffering and pain of all individuals at the end of life remains a constant for hospice providers, despite any changes to law and policy, he stated.

Hiring a diverse workforce that is representative of LGBTQ+ populations is among the keys to building trust and breaking down barriers according to Dresang. Engaging with these communities through focus groups is also important to understanding their biggest priorities and concerns related to end-of-life care, he added.

Staff training is additionally a significant part of improving outcomes, particularly when it comes to education around health conditions that are uniquely common among LGBTQ+, utilization of inclusive language and having clearly established non-discrimination policies.

Many hospice organizations have integrated nondiscrimination clauses that specifically mention sexual orientation and gender identity in their patient bill of rights statements that outline individuals’ right to receive care without prejudice, Dresang said.

“It was not policy or regulation that made a difference, it was humans and their humane response to random suffering that changed everything,” Dresang said. “We, in end-of-life care, need to stay the course.”