Federal Judge Overturns Trump-Era Ban on Gender-Affirming Care for Children
A federal judge overturned the Trump administration’s ban on gender-affirming care for children on Saturday, condemning Robert F. Kennedy Jr.’s “wanton disregard” for the law that “causes very real harm to very real people.”
This ruling marks another setback for Kennedy’s agenda as secretary for the US Department of Health and Human Services (HHS) under the second Trump administration, an agenda focused on restricting healthcare access, including vaccines, abortion, and gender-affirming care.
Recent legal decisions have challenged the agency’s efforts to dismantle vaccine recommendations, and new scientific studies have undermined controversial claims made by Trump and Kennedy regarding autism.
Judge Kasubhai’s Strong Criticism of Administration’s Actions
Mustafa T. Kasubhai, a US district judge in Oregon, opened his 49-page decision on the gender-affirming care case by stating:
“Unserious leaders are unsafe.”
The ruling excoriated the administration for disregarding the law and overreaching in its regulations. The judge also barred the administration from implementing similar policies under any other names to restrict care nationally by withholding funding.
Legal and Community Responses
Shannon Minter, legal director of the National Center for LGBTQ Rights, described the ruling as:
“Incredibly powerful” and “far-reaching.”
Minter added,
“It enjoins them from doing anything to interfere with the authority of states to regulate medical practice.”
Jan Oosting, associate professor of nursing at City University of New York (CUNY), noted the impact for healthcare providers and families who have faced uncertainty for months:
“This is a huge, huge step forward.”
Khadijah Silver, director of gender justice and health equity at Lawyers for Good Government, expressed their reaction:
“I was so overwhelmingly ecstatic and couldn’t actually process that the ruling was real life.”
Background on Kennedy’s Policy and Its Implications
In December, Kennedy announced that any health system providing pediatric gender-affirming care would be suspended from receiving Medicaid and Medicare funding. He also stated that Medicaid and Medicare would be banned from paying for any gender-affirming care.
Since nearly all major hospitals and health systems rely on Medicaid and Medicare, the proposed rule effectively amounted to a ban on gender-affirming care for children, setting a precedent for government limitations on healthcare access for any patients.
Simultaneously, Kennedy issued a declaration invoking a regulation to allow HHS to exclude healthcare providers from Medicaid and Medicare when they no longer “meet professionally recognized standards of healthcare.” Unusually, this new rule was enforced immediately, bypassing the usual rule-making process, including public comment.
Details on Gender-Affirming Care and Medical Standards
Gender-affirming care often includes puberty blockers and hormones but can also involve psychosocial support and, very rarely and after extensive medical consultation, surgery. It is widely recognized as essential to the health of gender-expansive individuals.
The Kennedy declaration claimed pediatric gender-affirming care for minors was “neither safe nor effective” and therefore fell below these standards.
Silver explained the intended use of such declarations:
“They have never once been abused in such a fashion to go against standards of medical care that are widely accepted … let alone to override the state’s primary authority in the regulation of medicine.”
Minter added,
“This was an attempt by the federal government to impose a national ban and usurp the authority of states to regulate medical practice within their borders.”
Enforcement and Legal Challenges
Within eight days of the declaration, HHS general counsel Mike Stuart began referring health systems to the HHS Office of Inspector General for violating the new policy. The judge’s decision included screenshots of Stuart’s posts celebrating these referrals.
At least several health systems have stated that the threat of losing federal funding caused them to stop providing care in recent weeks. Oregon and 21 other states sued the administration. In response, the US government argued that the Kennedy declaration was merely an individual’s personal opinion.
The judge rejected this argument as:
“A bald-faced lie” and an attempt to “bully or gaslight” the court.
He ruled the Kennedy declaration “clearly unlawful” because it violated administrative law and the Medicare statute that forbids federal officials from exercising “any supervision or control over the practice of medicine or the manner in which medical services are provided.”
Effects of the Injunction and Ongoing Litigation
Following the judge’s preliminary injunction against the new rule in March, some health systems resumed offering gender-affirming care.
When Children’s Hospital Colorado ceased care, patients and families sued the hospital. The case is currently before the Colorado Supreme Court, where judges have expressed concerns that forcing the hospital to resume care could provoke federal backlash, potentially endangering more children. Silver noted that reversing the federal ban now could influence the outcome of that case.
Minter stated,
“This should be a huge relief and a tremendous source of protection”
for families and children whose care was delayed or disrupted. He criticized the prior behavior of health systems that complied with the directive and stopped providing care immediately as:
“Shocking and appalling behavior.”
He added that the decision should remove that fear and allow care to resume.
Oosting observed that:
“The biggest source of fear, which was the threat of losing Medicare and Medicaid funding, is removed now, so I think that there will be reassessment by each individual hospital of what programs are going to be put back into play, what programs will have to be modified.”
She noted this is especially true in states like New York that have laws against discrimination in healthcare.
The proposed rule preventing Medicaid and Medicare from paying for gender-affirming care is also blocked by this decision, according to Minter. Although the rule has not been finalized and thus was not before the judge, Minter interprets the ruling as:
“Effectively prohibiting those rules from being enforced as well.”
Remaining Challenges and Broader Implications
Challenges remain for children needing gender-affirming care who may not be able to access it due to state-level restrictions.
Oosting noted,
“Although this removes a major federal barrier, it doesn’t erase those state-level restrictions.”
Some states have introduced bans on gender-affirming care. In Ohio, the state’s Supreme Court will soon rule on the constitutionality of such a ban.
Some families in states with bans or gaps in healthcare have been able to access care by moving or traveling out of state—a process described by Minter as “burdensome,” disruptive, and expensive, but an “important” option.
Oosting described the overturning of the ban as:
“A meaningful win for patients and providers and, honestly, for healthcare integrity in the US.”
She explained that it reduces fear and uncertainty around seeking and providing care and demonstrates that major healthcare policy changes must comply with the law. This has implications for other politicized health regulations, such as abortion limitations.
Minter added,
“It was a powerful tool to stop the federal government from that type of attempted overreach” in healthcare.
The decision reinforces that:
“The federal government can’t use Medicare and Medicaid restriction as a blunt-force instrument to control care and access to people’s bodies.”
Oosting emphasized the significance of the ruling not only for restoring gender-affirming care but also for establishing limits on federal influence over patient care decisions:
“It sets the rules of the road – how far the federal government can go in terms of influencing what’s happening in a patient exam room.”
