Full Breakdown
Hospitals Remain Silent on Resuming Gender-Affirming Care After Court Overturns HHS Directive
4/28/2026, 2:59:42 AM
Federal Court Overturns HHS Directive
On April 18, 2024, a federal judge in Oregon ruled that the December directive issued by Robert F. Kennedy Jr., the Trump administration’s secretary of the U.S. Department of Health and Human Services, exceeded federal authority and conflicted with existing law. The decision affirms that hospitals cannot lose Medicaid or other federal health-program funding for providing gender-affirming care to minors, but it does not compel any facility to offer such services.
Background: Trump Administration’s Gender-Affirming Care Directive
In December 2023, Kennedy announced that hospitals nationwide must cease providing gender-affirming care to minors or risk losing federal health-program funds, including Medicaid. The directive was widely criticized by health-care experts and LGBTQ+ advocates as legally invalid. Anticipating funding repercussions, many hospitals discontinued services before any enforcement action occurred.
Hospitals That Suspended Care
The hospitals that halted gender-affirming programs in advance of the directive include:
- University of Michigan Health (Michigan)
- Fenway Health (Boston, Massachusetts)
- Rady Children’s Hospital (San Diego, California)
- Yale New Haven Health (Connecticut)
- Connecticut Children’s Medical Center (Connecticut)
- NYU Langone Health (New York)
- Mount Sinai Health System (New York)
- Children’s National Hospital (Washington, D.C.)
None of these institutions have confirmed plans to reopen their programs following the court ruling. Mount Sinai declined comment; the others did not respond to inquiries.
Official Statements & Responses
- The Oregon judge’s opinion clarified that the HHS directive “overstepped the federal government’s role” and cannot be used to withhold federal funds.
- New York Attorney General Letitia James issued an order requiring New York hospitals to maintain access to gender-affirming services in compliance with state nondiscrimination statutes.
- The U.S. House of Representatives passed legislation to block Medicaid coverage of gender-affirming care for youth; the bill remains pending in the Senate.
- State legislatures have introduced hundreds of bills targeting transgender rights in education, bathroom access, and identity documentation, according to the American Civil Liberties Union.
Criticism & Opposition
Health-policy officials and LGBTQ+ advocates denounced the Kennedy directive as “legally invalid” and warned that preemptive discontinuations jeopardized patient health. Adrian Shanker, former deputy assistant secretary for health policy under President Joe Biden, emphasized that the policy was fabricated and that the resulting service gaps harm trans youth.
On-the-Ground Impact
Transgender youth across the United States continue to face limited access to gender-affirming care. Some families must seek care outside traditional hospital settings or travel to facilities that have resumed services, such as Children’s Minnesota, which reopened its trans-health program after the court decision. Shanker noted that the absence of care “saves lives” but that patients bear the worst consequences when services are unavailable.
Conflicting Reports & Gaps
The court’s ruling removes the funding threat but does not obligate hospitals to restart programs, leaving the timeline for service restoration uncertain. No hospital has publicly announced a reopening plan, and the lack of responses creates a gap in understanding how quickly care may be restored.
Verbatim Quotes
- “RFK Jr. literally made up a process where he could sign a declaration and declare gender-affirming care to be, in his view, unsound,” — Adrian Shanker, Deputy Assistant Secretary for Health Policy
- “Unfortunately, many hospitals discontinued care preemptively.” — Adrian Shanker
- “We’re not going to have a clear resolution about trans care in the United States very soon,” — Adrian Shanker
- “There’s going to be additional Trump administration actions [and] court cases leading to judicial decisions.” — Adrian Shanker
- “Despite the rhetoric from the Trump administration, we actually know that gender-affirming health care saves lives,” — Adrian Shanker
- “Unfortunately, it’s patients who experience the worst impacts when care is not available.” — Adrian Shanker
What’s Next
Legal analysts expect further litigation and possible administrative actions from the Trump administration. State legislatures will continue advancing bills affecting transgender rights, while hospitals may reassess service offerings in response to state nondiscrimination orders and evolving federal guidance. The interplay of court decisions, federal policy, and state law will shape the availability of gender-affirming care for trans youth in the coming months.
