Dear Hospital Administrators, Colleagues, and Grant Recipients:

March 6, 2025

The behavioral health needs of children, youth, and their families are one of the Health
Resources and Services Administration’s (HRSA) highest priorities.  As you may know, the
Department of Health and Human Services (HHS), through the Centers for Medicare and
Medicaid Services (CMS) sent a Quality and Safety Special Alert Memo (QSSAM) yesterday,
alerting providers to the dangerous chemical and surgical mutilation of children, including
interventions that cause sterilization. The QSSAM reminds providers of their duty to serve all
patients, especially children, with dignity and adherence to the highest standard of care that is
informed by robust evidence and the utmost scientific integrity.  The memo notes that the United
States is now an outlier in the treatment of gender-dysphoria in children, as the United Kingdom,
Sweden, and Finland have recently issued restrictions on the use of puberty blockers and cross-
sex hormones for children.

Moving forward, HRSA will review its policies, grants and programs in light of the concerns
discussed in the QSSAM and may begin taking steps in the future to appropriately update its
policies to protect children from chemical and surgical mutilation.  HRSA will follow any
applicable substantive and procedural requirements in taking any future action.

HRSA’s review will include its Children’s Hospitals Graduate Medical Education (CHGME)
Payment Program.  In particular, HRSA will examine the $367.2 million that was awarded in
fiscal year 2024 to 59 free-standing children’s hospitals nationwide in light of the concerns
discussed in the QSSAM.  HRSA may also consider re-scoping, delaying, or potentially
cancelling new grants in the future depending on the nature of the work and any future policy
change(s) HRSA may make.

Thank you for your continued partnership with HHS and HRSA and for your cooperation as we
work together to improve the health and well-being of the children of this country and to Make
America Healthy Again.  The QSSAM’s message to providers on the dangerous chemical and
surgical mutilation of children, including interventions that cause sterilization, was informed by a
growing body of evidence and protective policies in other developed countries.  HRSA may
begin taking steps to appropriately update its policies to protect children from chemical and
surgical mutilation.

Sincerely,

Thomas J. Engels
Administrator

