States Challenge HHS Declaration on Youth Gender-Affirming Care
A legal challenge has been initiated by 19 states and the District of Columbia against the U.S. Department of Health and Human Services (HHS), its secretary, Robert F. Kennedy Jr., and its inspector general. The lawsuit, filed on Tuesday, targets a recent declaration that could impact access to gender-affirming care for minors.
Issued last Thursday, the declaration labeled treatments such as puberty blockers, hormone therapy, and surgeries as both unsafe and ineffective for children and adolescents with gender dysphoria. It also suggested that healthcare providers offering these services could face exclusion from federal health programs, including Medicare and Medicaid.
Additionally, HHS unveiled proposed regulations intended to restrict gender-affirming care for young individuals, although these are not yet finalized and are not currently addressed in the lawsuit.
The lawsuit, lodged in the U.S. District Court in Eugene, Oregon, asserts that the declaration is both inaccurate and unlawful, seeking its enforcement to be blocked. This legal action is part of a broader conflict between the current administration’s efforts to limit transgender healthcare for minors and advocates who argue for its necessity.
“Secretary Kennedy cannot unilaterally change medical standards by posting a document online, and no one should lose access to medically necessary health care because their federal government tried to interfere in decisions that belong in doctors’ offices,” stated New York Attorney General Letitia James, who spearheaded the lawsuit.
The legal complaint argues that HHS’s declaration aims to intimidate providers into halting gender-affirming care and bypasses legal requirements for enacting policy changes. It claims that federal law mandates public notification and commentary before significant health policy modifications, which the declaration allegedly ignored.
HHS has declined to comment on the lawsuit. The declaration’s conclusions were derived from a peer-reviewed report by the department earlier this year, emphasizing behavioral therapy over gender-affirming care for youths with gender dysphoria.
The report questioned the standards set by the World Professional Association for Transgender Health, raising concerns about the ability of adolescents to consent to treatments with potential lifelong implications, such as infertility. However, major U.S. medical organizations, including the American Medical Association, continue to support transgender care for minors and have criticized the report as inaccurate.
HHS’s declaration and proposed rules are part of an ongoing initiative to limit gender-affirming healthcare for minors, following previous efforts during the Trump administration. The new proposals, which are not yet legally binding, would cut off federal Medicaid and Medicare funding to hospitals providing these services and prevent federal Medicaid dollars from covering such procedures.
Although the rules require a comprehensive rulemaking process and public input before becoming permanent, they could nonetheless deter healthcare providers from offering these services. Several providers have already reduced gender-affirming care for young patients following the return of the Trump administration, even in states where the care remains legal and protected.
Currently, Medicaid programs in less than half of the states cover gender-affirming care, with at least 27 states having laws that restrict or ban such care. A recent Supreme Court decision affirming Tennessee’s ban suggests that similar state laws are likely to persist.
The lawsuit, led by Letitia James, is supported by Democratic attorneys general from California, Colorado, Connecticut, Delaware, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, New Jersey, New Mexico, Oregon, Rhode Island, Vermont, Wisconsin, Washington, and the District of Columbia. Pennsylvania’s Democratic governor has also joined the legal effort.
