HHS posted a declaration labeling puberty blockers, hormone therapy and surgeries for minors with gender dysphoria as unsafe and warned providers they could face exclusion from federal health programs. A coalition of 19 states and the District of Columbia sued to block the declaration, arguing it is legally flawed, factually inaccurate and issued without required notice and public comment. HHS based its declaration on an internal peer‑reviewed report that many major medical organizations have disputed. The case could determine whether the declaration can be enforced while the legal challenge proceeds.
19 States and D.C. Sue HHS to Block Declaration That Could Restrict Youth Gender‑Affirming Care
Secretary of Health and Human Services, Robert F. Kennedy, Jr., speaks during an event on prescription drug prices in the Roosevelt Room of the White House, Friday, Dec. 19, 2025, in Washington. (AP Photo/Evan Vucci)
NEW YORK (AP) — Nineteen states and the District of Columbia on Tuesday filed suit against the U.S. Department of Health and Human Services (HHS), Secretary Robert F. Kennedy Jr., and the department’s inspector general, challenging a recent HHS declaration that they say could make it harder for minors to obtain gender‑affirming medical care.
What HHS Said
Last Thursday HHS posted a declaration calling interventions such as puberty blockers, hormone therapy and gender‑affirming surgeries “unsafe and ineffective” for children and adolescents diagnosed with gender dysphoria — the distress that can arise when a person’s gender identity or expression does not match the sex assigned at birth. The declaration also warned clinicians that providing such care could expose them to exclusion from federal programs like Medicare and Medicaid.
The Lawsuit
The multistate complaint, filed in U.S. District Court in Eugene, Oregon, asks a federal judge to block enforcement of the declaration. Plaintiffs led by New York Attorney General Letitia James argue the declaration is both factually inaccurate and unlawful. They contend HHS effectively sidestepped required rulemaking procedures — including notice and an opportunity for public comment — and improperly pressured providers to stop offering care.
“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,” said AG Letitia James.
Basis for HHS Action and Medical Community Response
HHS said its declaration was informed largely by a peer‑reviewed departmental report released earlier this year that recommended greater reliance on behavioral therapies and questioned broad use of medical interventions for adolescents. That report also raised concerns about adolescents’ ability to give informed consent for treatments that may carry long‑term consequences, including potential infertility.
Major medical organizations and clinicians who treat transgender youth have strongly criticized the department’s report, calling it flawed and disputing its conclusions. Most leading U.S. medical groups, including the American Medical Association, continue to oppose broad restrictions on gender‑affirming care for young people.
Related Proposed Rules And Potential Impact
HHS also released two proposed rules: one that would cut Medicare and Medicaid funding to hospitals that provide gender‑affirming care to minors, and another that would bar federal Medicaid dollars from being used for such procedures. Those proposals are not final and must go through a rulemaking process, including public comment, before they could take effect. Still, legal and regulatory shifts of this kind have already prompted some health systems to scale back or alter services for youth.
Legal And Political Context
Medicaid programs in slightly fewer than half of U.S. states currently cover gender‑affirming care. At least 27 states have enacted laws restricting or banning these treatments for minors. The complaint notes a recent Supreme Court decision upholding Tennessee’s ban and warns that federal actions could further chill provider willingness to offer care even where state law protects it.
Who Joined The Suit
Joining New York in the litigation were 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 action. An HHS spokesperson declined to comment.
What’s Next
The court will consider the plaintiffs’ request for an injunction. If the injunction is granted, HHS would be barred from enforcing the declaration while the case proceeds. The suit frames the dispute as a clash between federal administrative action and medical‑practice standards determined by clinicians and professional organizations.
