Nineteen states are suing to block the Department of Health and Human Services (HHS) announcement last week of a proposed rule to end all federal funding for any hospital in the United States that provides gender-affirming care to minors.

The funding threat announced last Thursday by HHS Secretary Robert F. Kennedy would deny Medicare and Medicaid funding to any hospital that provides puberty blockers, hormone therapy, and, in rare instances, surgeries for trans youth.

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Federal funding makes up about 45% of total spending on hospital care, according to KFF, the nonprofit health policy research group.

Kennedy based the action in part on a claim that gender-related treatments for minors “fail to meet professional recognized standards of health care,” a finding in a highly criticized report commissioned by HHS on the treatment of pediatric gender dysphoria released in May and updated last month.

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The states argue in their suit that Kennedy’s declaration is unlawful government overreach.

“Secretary Kennedy cannot unilaterally change medical standards by posting a document online,” New York Attorney General Letitia James said in a statement on Tuesday. “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.”

HHS asserts the order supersedes previously established standards of care and that the agency can exclude hospitals from federal programs that fail to meet new standards. 

Those standards are based on Donald Trump’s Day One “gender ideology” executive order mandating the government recognize only two “immutable” sexes, male and female, and another addressing the so-called “chemical surgical mutilation” of children. Both underpin Trump’s crusade against transgender identity.

The suit argues that regulating medical practice falls under the states’ jurisdiction.

“By attempting to impose a single nationwide standard and threatening to punish providers who adhere to well-established, evidence-based care, HHS is unlawfully interfering in decisions that should be made by doctors and their patients,” James’s office said.

States joining the suit, filed in federal court by Oregon Attorney General Dan Rayfield, include California, Colorado, Connecticut, Delaware, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, New Jersey, New Mexico, Oregon, Pennsylvania, Rhode Island, Vermont, Wisconsin, and Washington, and the District of Columbia. All have Democratic-controlled legislatures, governors, or both, The New York Times reports.

The states are suing as healthcare providers are already relenting to pressure to end gender-affirming care for minors, and options for the treatment of gender dysphoria dwindle for patients. More than two dozen states have banned the practice.

Children’s Hospital Los Angeles notified staff members in June that the clinic would close, citing the potential termination of federal funds, which account for 65 percent of its budget. Loss of that funding would be “an existential threat to our hospital operations,” they said at the time.

The day before Kennedy’s announcement, the House of Representatives passed a bill sponsored by outgoing Rep. Marjorie Taylor Greene (R-GA) that would criminalize gender-affirming care for minors nationwide, subjecting providers to up to 10 years in federal prison.

At the HHS news conference last Thursday, Jim O’Neill, deputy secretary of the department, asserted, “Men are men. Men can never become women. Women are women. Women can never become men.”

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