The Trump administration announced dramatic plans Thursday to essentially end access to gender-affirming care for minors nationwide — even in states where it is legal.

Health and Human Services Secretary Robert F. Kennedy Jr. unveiled several actions the agency will take to halt what he calls “sex rejecting treatments.”

The Centers for Medicare and Medicaid Services proposed new rules to prohibit hospitals from providing puberty blockers, hormone therapy and surgeries to minors as a condition of participation in Medicare and Medicaid, and to prevent Medicaid funding from being used for this care.

The proposed rules, which were first reported in October, are not final and cannot go into effect until after a 60-day period of public comment.

While speaking at an HHS meeting, Kennedy said this would essentially bar “almost all hospitals” from providing gender-affirming care to minors, something he referred to as “malpractice.”