States file lawsuit challenging federal limits on gender-affirming care

Todd Karpovich, The Baltimore Sun on Dec 24, 2025

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BALTIMORE — A coalition of states filed a lawsuit this week challenging a recent action by the U.S. Department of Health and Human Services that seeks to restrict access to gender-affirming care for transgender youth.

The suit, filed in federal court, asks a judge to block what HHS has labeled a “declaration,” issued Dec. 18, asserting certain forms of gender-affirming care are unsafe and ineffective. The declaration also warns that doctors, hospitals and clinics continuing such care could face exclusion from federal Medicare and Medicaid programs.

HHS also announced two proposed rules that would bar providers and hospitals offering such care from participating in Medicare and Medicaid programs and prohibit Medicaid payments for gender-affirming care. Those proposed rules are not yet in effect. HHS has opened a public comment period that runs through Feb. 17.

The coalition contends that the federal agency is using the declaration as an improper workaround to impose immediate nationwide policy changes without public input or consultation with medical professionals, patients, or state governments.

Federal law, the attorneys general argue, requires agencies to solicit public comment before implementing significant healthcare policy changes. Such action also unlawfully encroaches on states’ longstanding role in regulating medicine, the lawsuit argues.

“Health care decisions should be made by doctors and patients — not by politicians in Washington threatening to destroy providers’ careers and spreading fear among transgender youth and their families,” Maryland Attorney General Anthony G. Brown said in a statement. “This isn’t just about following the law — though HHS is clearly violating it. This is about protecting vulnerable young people who deserve the same dignity, respect, and access to medical care as anyone else.”

HHS officials could not be reached for comment.

The coalition also argues that providers could face pressure to stop offering care or risk losing access to Medicare and Medicaid, potentially shrinking provider networks and limiting care not only for transgender patients but for millions of Medicaid recipients who rely on those systems. Disqualifying providers could worsen health care workforce shortages and destabilize Medicaid programs by forcing doctors and hospitals to choose between treating patients and protecting their livelihoods, the coalition said in its lawsuit.

Joining Maryland's Brown in the suit are the attorneys general of California, Colorado, Connecticut, Delaware, Illinois, Maine, Massachusetts, Michigan, Minnesota, New Jersey, New Mexico, New York, Oregon, Rhode Island, Vermont, Washington and Wisconsin, as well as officials from the District of Columbia and the governor of Pennsylvania.

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