A coalition of 19 states and the District of Columbia filed a lawsuit Tuesday against the U.S. Department of Health and Human Services (HHS), its secretary Robert F. Kennedy Jr., and its inspector general. The suit challenges a declaration issued last Thursday that brands puberty blockers, hormone therapy and surgeries for transgender youth as unsafe and ineffective, and warns doctors that they could lose access to Medicare and Medicaid if they provide such care.
The Lawsuit
The case was filed in U.S. District Court in Eugene, Oregon. New York Attorney General Letitia James, who led the action, said in a statement, “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.” The complaint alleges that the declaration seeks to coerce providers to stop offering gender-affirming care and bypasses legal requirements for policy changes. It also claims that federal law requires notice and a comment period before substantive health policy changes, neither of which was observed before the declaration.
Content of the Declaration
The declaration defines gender dysphoria as the distress that arises when a person’s gender expression does not match the sex assigned at birth. It states that treatments such as puberty blockers, hormone therapy and surgeries are unsafe and ineffective for children and adolescents. The document warns that physicians who provide these services may be excluded from federal health programs, including Medicare and Medicaid.
Proposed Rules That Follow
On the same Thursday, HHS announced two proposed federal rules. One would cut off Medicaid and Medicare funding from hospitals that provide gender-affirming care to children. The other would prohibit federal Medicaid dollars from being used for such procedures. The proposals are not final and must undergo a lengthy rulemaking process and public comment before becoming binding.
Medical Community Response
HHS based its conclusions on a peer-reviewed report conducted earlier in the year that urged greater reliance on behavioral therapy rather than broad gender-affirming care for youths with gender dysphoria. The report questioned standards issued by the World Professional Association for Transgender Health and raised concerns that adolescents may be too young to consent to life-changing treatments that could affect future fertility. Major medical groups and providers treating transgender youth have called the report inaccurate. The American Medical Association and other U.S. medical organizations continue to oppose restrictions on transgender care for young people.
The Coalition
The lawsuit is joined 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 also joined the suit.
Context in the United States
Medicaid programs in slightly less than half of states currently cover gender-affirming care. At least 27 states have enacted laws that restrict or ban such care. The Supreme Court’s recent decision upholding Tennessee’s ban means most other state laws are likely to remain in place.
Key Takeaways
- 19 states and DC sued HHS over a declaration labeling gender-affirming care for youth unsafe.
- The declaration warns doctors could lose Medicare and Medicaid access if they provide puberty blockers, hormones or surgeries.
- HHS also proposed rules that would cut federal funding for hospitals offering gender-affirming care to children.
The lawsuit marks the latest confrontation between a federal administration that seeks to limit transgender health services for children and advocates who argue the care is medically necessary.
