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Trump Administration Continues Campaign Against Transgender Community

By PWDF Staff

Agencies within the federal government are following a path laid out in January 2025 when President Trump began signing executive orders aimed at dismantling protections for members of the LGBTQ+ community.

For example, on January 28, 2025, the President signed Executive Order 14187 (“Protecting Children from Chemical and Surgical Mutilation”),[1] making it U.S. policy not to “fund, sponsor, promote, assist, or support” gender transition for people under age 19. The order threatened to pull federal funding from medical institutions that provide this type of care.

Also, US Department of Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr., has announced a proposed rule change to Section 504 of the Rehabilitation Act of 1973 (Section 504) that would delete nondiscrimination protections for people with gender dysphoria.[2] On February 20, 2026, People With Disabilities Foundation (PWDF) joined 148 other disability civil rights agencies from across the nation in signing a petition, originated by the National Women’s Law Center, to HHS’s Office for Civil Rights strongly objecting to this proposed change, “Nondiscrimination on the Basis of Disability in Programs or Activities Receiving Federal Financial Assistance.”

Ban on Gender-Affirming Care for Minors

On Dec. 18, 2025, Kennedy and Dr. Mehmet Oz, Administrator of the Centers for Medicare and Medicaid Services (CMS), jointly unveiled proposed new rules that would ban gender-affirming care for minors across the U.S. healthcare system sometime in 2026. (Note: The Trump administration refers to these treatments as “sex-rejecting procedures.”)

Under CMS’s proposed rule, “Hospital Conditions of Participation”,[3] hospitals participating in Medicare and Medicaid programs would be prohibited from performing a “sex-rejecting procedure” to anyone under the age of 18. That includes “any pharmaceutical or surgical intervention that attempts to align a child’s physical appearance or body with an asserted identity that differs from the child’s sex.” This covers use of puberty blockers, hormones and surgery.

Also, Medicaid and the Children’s Health  Insurance Program (CHIP),[4] run by the states would explicitly prohibit the use of federal funds for gender-affirming procedures for individuals under age 18 (Medicaid) and age 19 (CHIP). These proposed changes would not prevent states from “providing coverage for sex-rejecting procedures with State-only funds outside the federally-matched Medicaid program or CHIP,” according to HHS.

Since the majority of U.S. hospitals accept some form of Medicare and/or Medicaid funding, non-compliance could lead to catastrophic financial impacts, effectively forcing hospitals to deny these services to trans youth. Plus, while the rule does not explicitly bar adult care, legal experts and advocacy groups express concern that a severe risk of decertification by CMS might cause hospitals to voluntarily drop these services to all patients, regardless of age.

Three San Francisco Bay Area health care organizations announced in 2025 they were suspending or eliminating gender-affirming care for minors: Kaiser-Permanente, Stanford Medicine and Sutter Health.

According to the STAT health care industry newsletter,[5] more than 40 U.S. hospitals and/or health systems stopped or paused gender-affirming care to young people since January 2025. Several hospitals have already been referred to HHS’ Office of Inspector General for investigation since Dec. 18, 2025.

The state of New York, however, has ordered a major Manhattan hospital to resume providing puberty-blocking medication and hormone treatments to transgender adolescents, according to The New York Times.[6]

In a Feb. 25, 2026, letter to officials at NYU Langone Health, which closed its Transgender Youth Health Program two weeks prior, Darsana Srinivasan, who leads the New York Attorney General’s health care bureau, “raised the question whether (the hospital’s) action violated New York’s anti-discrimination laws, by barring a single category of patients from receiving medications that others could access,” according to the Times. Ms. Srinivasan pointed out that puberty blockers and hormone treatments remained available to pediatric patients who were not transgender.

The deadline to submit formal public comment on HHS’s proposed changes was Tuesday, Feb. 17, 2026. If finalized as written, the rules are expected to be published in early spring 2026 and then become effective 60 days later.[7]

Removal of Gender Dysphoria from List of Protected Disabilities

In a related move to withdraw protections for transgender individuals, HHS Secretary Kennedy announced on Dec. 18, 2025, that the Department is proposing a rule change that would revise the implementing regulations for Section 504 in order to exclude “gender dysphoria” from the definition of a protected disability.[8]

Gender dysphoria, according to the Diagnostic and Statistical Manual of Mental Disorders (5^th ed.),[9] is “a marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ duration.” And, “the condition is associated with clinically significant distress or impairment in social, school, or other important areas of functioning.” In children, a diagnosis should confirm six of eight established criteria, while in adolescents and adults, it is manifested by at least two of six criteria.

When the Americans with Disabilities Act (ADA) was passed by Congress in 1990, gender dysphoria had not yet been identified. “Gender identity disorder”, instead, was included on a list of psycho-sexual disorders and gender-related conditions not covered under the ADA. But, a 2022 ruling by the U.S. Fourth Circuit Court of Appeals in the case of Williams v. Kincaid[10] stated that gender dysphoria is not excluded from the ADA, making it the first federal appellate court to recognize it as a disability. The Supreme Court subsequently denied certiorari, leaving the Fourth Circuit’s judgment intact.

In 2024, the Biden Administration’s HHS stated in the preamble of a Final Rule expansion of its definition of a disability: “…an individual with gender dysphoria may have a disability under section 504 and that restrictions that prevent, limit, or interfere with otherwise qualified individuals’ access to care due to their gender dysphoria diagnosis, or perception of gender dysphoria, may violate section 504.”[11] That established a legal path for transgender individuals to seek reasonable accommodations and combat discrimination.

Secretary Kennedy said that language “betrayed the original intent of the laws.”[12] Under HHS’s proposed rule change,[13] the Department “makes clear that [it] interprets the exclusionary language ‘gender identity disorders not resulting from physical impairments’ to encompass gender dysphoria that does not result from physical impairment.”

Opponents say gender dysphoria is prevalent within the transgender community and dropping it from ADA protection would deny those individuals access to HHS-funded programs and enable government-sanctioned discrimination.

The public comment period for this particular rule change was Feb. 20, 2026.

Just as this e-newsletter article was being published, a federal judge in Oregon ruled that Secretary Kennedy had “overstepped” his legal authority when he declared in December 2025 that providers of gender-transition medical treatments for minors “do not meet professionally recognized standards.” The judge’s decision, according to news accounts, gives temporary relief to health care providers who furnish those services.[14]

The judge’s order does not appear to affect current rule-making efforts by HHS, as described in this article, to ban health care providers that provide gender-affirming care from receiving Medicare and/or Medicaid funds, as well as removing gender dysphoria from a list of protected disabilities.
We will monitor the situation and provide updates when appropriate.

[1]  Exec. Order No. 14187, 3 C.F.R. 8771 (2025).

[2] Nondiscrimination on the Basis of Disability in Programs or Activities Receiving Federal Financial Assistance, 90 Fed. Reg. 59478 (December 19, 2025).  Hereinafter Nondiscrimination on the Basis of Disability, 2025.

[3] Medicare and Medicaid Programs; Hospital Condition of Participation: Prohibiting Sex-Rejecting Procedures for Children, 90 Fed. Reg. 59463 (December 19, 2025).

[4] Medicaid Program; Prohibition on Federal Medicaid and Children’s Health Insurance Program Funding for Sex-Rejecting Procedures Furnished to Children, 90 Fed. Reg. 59441 (December 19, 2025).

[5] Theresa Gaffney, Amid federal pressure, more hospitals stop gender-affirming care for minors, STAT, Feb. 5, 2026 (last visited Mar. 11, 2026).

[6] Joseph Goldstein, N.Y. Attorney General Orders Hospital to Resume Youth Transgender Care, The New York Times, March 2, 2026.

[7] Editor’s Note: In reviewing CMS’s proposed rule “Nondiscrimination on the Basis of Disability in Programs or Activities Receiving Federal Financial Assistance,” PWDF found that CMS made errors in basic math that exaggerated the number of adolescents that have received hormone treatment.  They stated, “Another study documented that almost 0.2 percent (or almost 2 in every 1,000) of 17-year-olds [12] with private insurance received SRP hormone treatment between 2018 through 2022.[13 14]”.  A review of their calculations and the study they cited show that the data supported half that, i.e., closer to 0.1 percent.  CMS’s footnote references are left here so the reader can locate the error.

[8] Nondiscrimination on the Basis of Disability 2025, supra note 2.

[9] American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5^th ed.), pp. 451-53.

[10] Williams v. Kincaid, 45 F.4th 759 (4th Cir. 2022).

[11] Nondiscrimination on the Basis of Disability in Programs or Activities Receiving Federal Financial Assistance,89 Fed. Reg. 40066 (May 9, 2024).

[12] US Dept. of Health & Human Services press conference on Sex Rejecting Procedures for Children, C-SPAN, Dec. 18, 2025, available at https://www.youtube.com/watch?v=dWxEylV7o2g

[13] Nondiscrimination on the Basis of Disability 2025, supra note 2.

[14] Judge rules US government overreached with transgender health care declaration, Associated Press, March 20, 2026.  See also Amy Harmon, Judge Rules That R.F.K. Jr. Overstepped on Transgender Care, The New York Times, March 19, 2026.

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People With Disabilities Foundation is an operating 501(c)(3) nonprofit organization based in San Francisco, California, which focuses on the rights of the mentally and developmentally disabled.

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