States vs. HHS: 19 Attorneys General Sue over Federal Warning on Youth Gender-Affirming Care

NPR, the New York Times, and Reuters contributed to this report.

A coalition of 19 states plus Washington, DC is taking the Trump administration to court after the US Department of Health and Human Services (HHS) issued a declaration that critics say could make it harder for young people to access gender-affirming care.

The lawsuit, filed Tuesday in federal court in Eugene, Oregon, names HHS, Health Secretary Robert F. Kennedy Jr., and the agency’s inspector general. At the heart of the dispute is a declaration posted last Thursday that labeled treatments such as puberty blockers, hormone therapy, and surgeries as unsafe and ineffective for minors with gender dysphoria — and warned that doctors providing that care could be shut out of federal health programs like Medicare and Medicaid.

The states argue that the declaration is inaccurate and unlawful, and they’re asking the court to block it from being enforced. New York Attorney General Letitia James, who is leading the case, summed up the states’ position bluntly: the health secretary, she said, can’t “unilaterally change medical standards by posting a document online,” and patients shouldn’t lose access to care because the federal government is trying to muscle into decisions “that belong in doctors’ offices.”

The lawsuit also accuses HHS of trying to pressure providers into backing away from care without following the usual legal playbook. The states say that under federal law, major health policy changes typically require public notice and a chance for public comment — and they argue neither happened here.

HHS declined to comment.

The declaration leans on a peer-reviewed HHS report from earlier this year that urged more reliance on behavioral therapy for youth with gender dysphoria instead of broad access to medical interventions. That report also questioned the standards promoted by the World Professional Association for Transgender Health, and raised concerns about whether adolescents can consent to treatments that could have long-term effects, including potential infertility.

But major medical organizations and clinicians who provide this care have pushed back hard, calling the report inaccurate. Many large US medical groups — including the American Medical Association — continue to oppose restrictions on gender-affirming care for young people.

The court fight lands in the middle of a broader national squeeze on transgender health care. HHS also unveiled two proposed federal rules last Thursday that, if finalized, would further limit care by cutting off Medicare and Medicaid funding for hospitals providing gender-affirming care to minors and restricting federal Medicaid dollars from being used for such procedures. Those proposals aren’t final yet — and the states’ lawsuit doesn’t directly challenge them — but critics say they could still have a chilling effect as providers weigh the risk.

The politics and the legal landscape are already messy. At least 27 states have adopted laws restricting or banning youth gender-affirming care, and Medicaid coverage varies, with slightly less than half of states covering it. The Supreme Court’s recent decision upholding Tennessee’s ban is expected to make it easier for other state restrictions to stand.

For now, the immediate question is narrower: can HHS use a declaration like this — with the threat of Medicare and Medicaid consequences — to effectively reshape medical practice nationwide? The states suing say no. The administration says it’s protecting kids. And the courts are about to decide how far federal power can go in the exam room.