More than a third of states sue HHS over a move that could curtail youth gender-affirming care

A coalition of 19 states and the District of Columbia filed a lawsuit Tuesday against the U.S. Department of Health and Human Services, challenging a recent declaration that could significantly limit access to gender-affirming care for transgender youth across the country.

The lawsuit, filed in U.S. District Court in Eugene, Oregon, targets HHS Secretary Robert F. Kennedy Jr. and the department’s inspector general over last week’s declaration that labeled treatments such as puberty blockers, hormone therapy, and surgeries as unsafe and ineffective for children and adolescents with gender dysphoria.

New York Attorney General Letitia James, who spearheaded the legal 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 HHS declaration, issued last Thursday, not only questioned the efficacy of gender-affirming treatments but also warned healthcare providers that they risk exclusion from federal health programs like Medicare and Medicaid if they continue to provide such care to young patients. This move represents a significant shift in federal health policy under the Trump administration.

The states’ lawsuit alleges that the declaration is both factually inaccurate and procedurally unlawful. According to the filing, HHS failed to follow federal requirements for policy changes, which typically mandate public notice and a comment period before implementing substantive shifts in healthcare regulations.

When asked for comment, an HHS spokesperson declined to respond to the litigation.

The declaration was based on a peer-reviewed report conducted by the department earlier this year, which advocated for greater emphasis on behavioral therapy rather than medical interventions for youth experiencing gender dysphoria. The report questioned established standards of care for transgender youth and raised concerns about adolescents’ ability to consent to treatments that could affect their future fertility.

This stance has drawn sharp criticism from major medical organizations. Groups like the American Medical Association continue to support access to gender-affirming care and oppose restrictions on such services for young people. Many healthcare experts have dismissed the HHS report as inaccurate and politically motivated.

Beyond the declaration, HHS also announced two proposed federal rules that would further restrict access to gender-affirming care. One would cut off federal Medicaid and Medicare funding from hospitals providing such care to children, while the other would prohibit federal Medicaid dollars from being used for these procedures.

Although these proposals are not yet finalized and must undergo a lengthy rulemaking process including public comment periods, they have already had a chilling effect on healthcare providers. Several major medical institutions have begun pulling back on gender-affirming care for young patients—even in states where such care remains legal and protected by state law.

Currently, Medicaid programs in just under half of U.S. states cover gender-affirming treatments. Meanwhile, at least 27 states have enacted laws either restricting or outright banning such care for minors. The Supreme Court’s recent decision to uphold Tennessee’s ban on gender-affirming care for minors has strengthened the legal foundation for these state-level restrictions.

The lawsuit represents the latest development in an escalating conflict between the administration’s efforts to curtail transgender healthcare and advocates who maintain that such care is medically necessary and should remain accessible.

Joining New York in the lawsuit are 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 challenge.

As the case moves through the courts, healthcare providers and transgender youth nationwide remain caught in a complex and rapidly changing policy landscape that could fundamentally alter access to care in the coming months.