19 states sue HHS over youth gender-affirming care : NPR

NEW YORK — A coalition of 19 states and the District of Columbia on Tuesday sued the U.S. Department of Health and Human Services, its secretary, Robert F. Kennedy Jr., and the inspector general over a declaration that could make it harder for young people to access gender-affirming care.

The declaration, released last Thursday, called treatments such as puberty blockers, hormone therapy and surgery unsafe and ineffective for children and adolescents experiencing gender dysphoria, or distress when someone's gender expression does not match their sex assigned at birth. He also warned doctors that they could be excluded from federal health care programs such as Medicare and Medicaid if they provided these types of care.

The announcement came as HHS also announced proposed rules aimed at further reducing gender-affirming care for young people, although the lawsuit does not address them because they are not final.

The lawsuit, filed Tuesday in U.S. District Court in Eugene, Oregon, claims the declaration is inaccurate and illegal and asks the court to block its enforcement. It is the latest in a series of clashes between the administration, which is tightening health care for transgender children, arguing it could be harmful to them, and advocates who argue such care is medically necessary and should not be restricted.

“Secretary Kennedy cannot unilaterally change medical standards by posting a document online, and no one should be denied access to medically necessary care because the federal government attempted to interfere with decisions that belong to doctors' offices,” New York Attorney General Letitia James, who led the lawsuit, said in a statement Tuesday.

The lawsuit alleges that HHS's declaration is intended to force providers to stop providing gender-affirming care and circumvent legal requirements to change policies. It says federal law requires the public to be notified and given an opportunity to comment before making significant changes to health care policy—neither of which the lawsuit says was done before the declaration was issued.

An HHS spokesman declined to comment.

The HHS announcement builds on a peer-reviewed report the department prepared earlier this year that called for greater reliance on behavioral therapy rather than broad gender-affirming care for young people with gender dysphoria.

The report questioned the standards of care for transgender youth set by the World Professional Association for Transgender Health and raised concerns that teenagers may be too young to consent to life-changing treatments that could lead to infertility in the future.

Major medical groups and those who treat transgender youth have sharply criticized the report as inaccurate, and most major U.S. medical organizations, including the American Medical Association, continue to oppose restrictions on transgender care and services for young people.

The announcement was announced as part of a multifaceted effort to limit gender-affirming health care for children and adolescents, and built on other efforts by the Trump administration to protect transgender rights across the country.

On Thursday, HHS also unveiled two proposed federal rules: one that would end federal Medicaid and Medicare funding from hospitals that provide gender-affirming care to children, and another that would prohibit the use of federal Medicaid dollars for such procedures.

The proposals are not yet final or legally binding and must go through a lengthy rulemaking process and public comment before becoming permanent. But they are nonetheless likely to further discourage health care providers from providing gender-affirming care to children.

Several major health care providers have already phased out gender-affirming care for young patients since Trump returned to office—even in states where the care is legal and protected by state law.

Medicaid programs in just under half of states now cover gender-affirming care. At least 27 states have passed laws restricting or banning care. A recent Supreme Court decision upholding Tennessee's ban means most other state laws will likely remain in place.

James was joined in Tuesday's suit 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.