SEATTLE—Attorney General Nick Brown is co-leading a federal lawsuit with Oregon and New York of 20 states and the District of Columbia challenging a declaration by U.S. Department of Health and Human Services (HHS) Secretary Robert F Kennedy Jr. that deems certain gender-affirming care for minors unsafe and ineffective, threatening to bar providers from participating in Medicare and Medicaid programs. The suit argues the move violates federal law by bypassing required procedures and overstepping the secretary’s authority.
“The law does not change on one man’s whim, and this care remains legal under federal and state law. The administration is stigmatizing young people and unlawfully trying to rob them of care that is lifesaving in some instances,” AG Brown said. “This action is as cruel and unnecessary as it is illegal, but consistent with an administration that puts politics above health.”
The complaint, filed Tuesday, December 23, in U.S. District Court in Eugene, Oregon, seeks to invalidate the HHS declaration which the plaintiffs say disrupts state Medicaid programs and undermines long-standing state authority over medical practice. They contend it creates immediate harm by forcing providers to choose between treating patients and risking exclusion from federal health programs.
The HHS declaration targets what it terms “sex-rejecting procedures” for children and adolescents, including puberty blockers, cross-sex hormones and surgeries. Gender-affirming care encompasses a range of social, psychological, behavioral and medical interventions designed to support and affirm an individual’s gender identity when it differs from their sex assigned at birth, according to the World Health Organization. Kennedy’s statement asserts these interventions fail to meet professional standards of health care and could lead to irreversible harm, such as infertility and impaired bone density.
“Under my leadership, and answering President Trump’s call to action, the federal government will do everything in its power to stop unsafe, irreversible practices that put our children at risk,” Secretary Kennedy said. “This Administration will protect America’s most vulnerable. Our children deserve better—and we are delivering on that promise.”
In the lawsuit, the plaintiffs argue the Trump administration establishes a new substantive legal standard without the mandated notice-and-comment rulemaking under the Administrative Procedure Act and Medicare statutes. The document cites no specific law granting Kennedy authority to declare national standards of care, relying instead on a regulatory definition that does not empower such actions.
The suit also claims the declaration exceeds Secretary Kennedy’s authority by attempting to control medical practice, which Congress explicitly prohibited federal officials from doing under the Medicare statute.
“Congress expressly prohibits any federal officer to exercise any supervision or control over the practice of medicine,” the lawsuit states.
Plaintiffs include states like California, Colorado, Connecticut, Delaware, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, New Jersey, New Mexico, Rhode Island, Vermont and Wisconsin, along with Pennsylvania Gov. Josh Shapiro in his official capacity. Each administers Medicaid and Children’s Health Insurance Program (CHIP) plans that cover gender-affirming care for minors when medically necessary, often backed by state laws protecting such treatments and shielding providers from out-of-state repercussions.
Oregon’s Medicaid plan includes gender-affirming treatments under a prioritized list of services approved by federal officials. Washington’s Apple Health program reimburses for these services and counts nearly 6,000 providers offering them. New York’s program covers hormone therapy and surgeries for those meeting criteria, with costs shared federally.
The suit warns that enforcing the declaration would devastate their health systems. It could exclude pediatricians, endocrinologists and hospitals, shrinking provider networks and limiting access to all care, not just gender-affirming treatments. States already struggle with provider shortages, and the threat could worsen them by deterring participation in Medicaid.
Centers for Medicare & Medicaid Services Administrator Dr. Mehmet Oz called gender-affirming procedures “unproven.”
“Children deserve our protection, not experimental interventions performed on them, that carry life-altering risks with no reliable evidence of benefit,” said CMS Administrator Dr. Oz. “This proposal seeks to clarify that hospitals participating in our programs cannot conduct these unproven procedures on children. CMS will ensure that federal program standards reflect our responsibility to promote the health and safety of children.”
HHS published a 14,000-person peer-review study of minors who received sex-rejecting procedures between 2019 and 2023, that current evidence does not support claims by health care providers, families, and policymakers that puberty blockers, cross-sex hormones, and surgeries are safe and effective treatments for pediatric gender dysphoria. HHS is also moving to reverse the Biden administration’s attempt to include gender dysphoria within the definition of a disability.
The U.S. Food and Drug Administration (FDA) has issued warning letters to 12 manufacturers and retailers for illegal marketing of breast binders to children for the purposes of treating gender dysphoria. Breast binders are Class 1 medical devices used for purposes such as assistance in recovery from cancer-related mastectomy. The warning letters formally notified the companies of their significant regulatory violations and how they should take prompt corrective action.
Tuesday’s lawsuit builds on prior legal wins, such as AG Brown’s earlier injunction against executive orders threatening funding for institutions providing gender-affirming care.
Brown’s office stressed that proposed rules are not yet law and nothing has changed in Washington, where such care remains legal and protected.
“Youth gender-affirming care in Washington is legal under state and federal law,” Mike Faulk, Deputy Communications Director for the AG’s Office told the Lynnwood Times. “We are following developments closely and will consider our options to defend young people’s access to this life-saving care.”
Author: Mario Lotmore
