Federal judge blocks RFK declaration targeting gender-affirming care (sex change for children)

The judge noted the case reflected a 'break it and see’ approach to governance.

by Monique Merrill, Court House News, March 19, 2026  (EDITED to eliminate Orwellian propaganda term “gender-affirming care”.)

EUGENE, Ore. (CN) — A federal judge on Thursday vacated a declaration from the Department of Health and Human Services that threatened to cut federal funding from medical professionals who provide gender-affirming care (sex change) for minors.

U.S. District Judge Mustafa Kasubhai ruled from the bench HHS Secretary Robert F. Kennedy Jr. exceeded his authority when he issued a declaration the judge said essentially modified the federally recognized standard of health care.

“It’s not merely an opinion; it has materially modified not even how the standards of care might be applied in gender-affirming care (sex change), but there is no standard of care that can be applied,” said Kasubhai, a Joe Biden appointee.

In the declaration, Kennedy stated “sex-rejecting procedures” — such as puberty blockers, hormone therapy and surgeries — are unsafe and ineffective ways to treat children and adolescents experiencing gender dysphoria that “fail to meet professional recognized standards of health care.”

He also warned doctors they may be excluded from federal health programs like Medicare and Medicaid if they provide those services, as they fail to meet professional standards.

A coalition of 21 states sued Kennedy and the department in late December, arguing the declaration seeks to coerce medical providers to stop providing gender-affirming care (sex change). The states also accused Kennedy of circumventing rulemaking requirements for policy changes.

Over the course of a six-hour hearing, attorneys for the states sparred with the Justice Department over whether the declaration qualified as a final agency action subject to legal requirements under both the Medicaid and Administrative Procedure Act, and whether Kennedy acted within his authority by releasing it.

The federal government argued the declaration was simply Kennedy expressing his opinion.

“This is his opinion after reviewing the medical research cited within, and the opinion he has formed is that certain types of treatments do not meet professionally recognized standards of care and are not supported by the greater weight of the evidence,” said Kathryn Alkire with the Justice Department. “This is an important issue to Secretary Kennedy.”

But the states argued the declaration exceeded that of an opinion and clearly directed the HHS Office of the Inspector General to exclude providers from federal health care programs like Medicare and Medicaid if they provide gender-affirming care (sex change).

In the declaration, Kennedy states the office may “exclude individuals or entities from participation in any federal health care program if the secretary determines the individual or entity has furnished or caused to be furnished items or services to patients of a quality which fails to meet professionally recognized standards of health care.”

The declaration also includes a section stating it supersedes statewide or national standards of care.

The states pointed to a post from the official HHS account on X in which it shared that its general counsel had referred Seattle Children’s Hospital to the Office of the Inspector General for failing to meet the standards outlined in Kennedy’s declaration by providing gender-affirming care (sex change) .

“It’s very clearly trying to set a new legal standard that would have consequences for the providers who are going through this exclusion process,” Allie M. Boyd, of the Oregon Department of Justice, argued, adding that the HHS treated the declaration as an authority and expected providers to immediately comply with it.

The states argued hospitals face devastating consequences when federal funding is cut.

“It effectively is a financial death sentence for the hospital, and not just for gender-affirming care (sex change) , for all services at that hospital,” Boyd said.

The federal government contended the declaration was a nonbinding opinion the Office of the Inspector General is free to disregard. Rather, the federal government argued the declaration was a general statement of policy that is exempt from legal rulemaking requirements.

Kasubhai agreed with the states.

“The declaration provides some very explicit, unequivocal statements about what falls below the professionally recognized standard of care as it relates to gender-affirming care (sex change),” Kasubhai said. “It is unambiguous, it does not provide for options or alternatives, it is clear that gender-affirming care (sex change) does not fall within that which is professionally recognized as standards of care.”

That amounts to a modification of the standard, which “effectively eliminated any consideration of any standard of care for people who are seeking gender-affirming care (sex change) in the plaintiff states,” Kasubhai said.

After granting summary judgment in favor of the states, Kasubhai commented that the case reflects a broader trend he’s noticed in administrative challenges.

“There’s a theme of ‘Break it and see what others will do,’ and that’s not a system or method committed to the rule of law,” Kasubhai said. “That notion that ‘I will go forward, issue a declaration and see if we can get away with it,’ that is not a principle of governance that adheres to the overarching commitment to the democratic public that requires the rule of law to be regarded and respected and honored as sacred.”

Oregon Attorney General Dan Rayfield celebrated Kasubhai’s ruling.

“The freedom to make personal healthcare decisions – with your family and your doctor – is a fundamental Oregon value,” Rayfield said in a statement. “It’s rooted in our belief that every person deserves dignity, compassion, and care. The court saw through the federal government’s attempt to bully hospitals and providers into abandoning their patients, and ruled on the side of those values.”

In addition to Oregon, the plaintiff states include California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, Rhode Island, Vermont, Washington, Wisconsin and Pennsylvania, along with the District of Columbia.

HHS did not immediately respond to a request for comment.