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Attorney General William Tong today joined a multistate coalition of 18 other attorneys general in suing to "ensure the Secretary of the U.S. Department of Health and Human Services (HHS) cannot threaten providers with a so-called declaration that baselessly and unlawfully attempts to limit access to gender-affirming care for young people."

The coalition argues that the declaration "falsely claims that certain forms of gender-affirming care are “unsafe and ineffective” and threatens to punish any doctors, hospitals, and clinics that continue to provide it with exclusion from the federal Medicare and Medicaid programs."

Attorney General Tong and the coalition argue that this declaration "violates federal statutes by unlawfully changing medical standards without going through the notice and comment process and undermining states’ long-standing authority to regulate medicine."

So, the coalition is asking the court to intervene and set aside the "unlawful and arbitrary" declaration.

“Trump and RFK Jr. are forcing a radical political agenda on doctors and families and weaponizing Medicare and Medicaid funding to deny healthcare to kids. These extreme actions threaten to decimate medical providers nationwide unless they end gender-affirming care, supplanting medical expertise and parental choice with MAGA ideology. This is cruel and lawless, and we’re suing to block them,” said Attorney General Tong.

This "radical political agenda" includes protecting children from harmful, experimental "gender affirming care" practices which have inflicted lasting physical and psychological damage on vulnerable young people.

As such, HHS published a "declaration on sex-rejecting procedures" on December 18th which included an “umbrella review” of existing systematic reviews on gender care, including those that informed European health authorities’ policy decisions, to assess their methodological quality and the evidence regarding the benefits and harms of hormonal and surgical interventions for treating pediatric gender dysphoria. The review found that the overall quality of evidence concerning the effects of sex-rejecting procedures on psychological outcomes, quality of life, regret, or long-term health, is very low.

The declaration also concluded that available evidence cannot support determinations regarding the effectiveness of medical and surgical interventions for mental health or alleviating gender dysphoria symptoms.

The declaration further states that pediatric medical transition evidence for benefit remains highly uncertain, while harm evidence demonstrates less uncertainty. The evidence compilation indicates that medical and surgical interventions for children and adolescents diagnosed with gender dysphoria present an unfavorable risk-benefit profile.

Known and plausible harm risks from puberty blockers, cross-sex hormones, and surgeries based on human physiology and pharmacological agents were identified. Short- and long-term adverse effects are likely, and include infertility and sterility, sexual dysfunction, impaired bone density development, adverse cognitive effects, cardiovascular and metabolic disease, psychiatric conditions, surgical complications, and regret

In the declaration, Secretary Kennedy also noted that, "under 42 U.S.C. § 1320a-7(b)(6)(B), the Secretary “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 agency also announced two proposed rules that would completely bar gender-affirming care providers and associated hospitals from participating in Medicare and Medicaid and ban payments for transgender health care through Medicaid. These rules have not yet gone into effect, and HHS has given the public until February 17, 2026 to submit comments on the proposals.

Attorney General Tong and the coalition argue that HHS is attempting to use the declaration to circumvent basic legal requirements for policy changes. Federal law requires agencies to provide the public with notice and an opportunity to comment before making significant changes to health care policy. The coalition further argued that "HHS issued what it arbitrarily called a declaration and attempted to make it effective nationwide immediately, without consulting doctors, patients, or states."

The attorneys general also contend that "this is a clear overreach by the federal government, given that HHS does not have the authority to take such an action" and that "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."

Note that the declaration details the inadequacy of existing transgender health care guidelines, which are not necessarily "well-established" or "evidence-based" and instead were described as "very low quality and should not be implemented."

Nonetheless, the attorneys general warn that the HHS will move will create "fear and uncertainty about whether ongoing care could suddenly be taken away" for transgender youth and their families.

They are also concerned that doctors and hospitals are being "threatened" with "severe penalties" for providing so-called gender-affirming care.

Lastly, the coalition is concerned that "by threatening to disqualify providers who offer gender-affirming care, the federal government is forcing doctors to choose between abandoning their patients or risking their livelihoods." The coalition believes this pressure would "reduce access to care, worsen provider shortages, and harm Medicaid patients far beyond those seeking gender-affirming care."

Attorney General Tong and the coalition are asking the court to rule the HHS declaration unlawful and block its enforcement.

Joining Attorney General Tong in this lawsuit, which was led by the attorneys general of New York, Oregon, and Washington, are the attorneys general of California, Colorado, Delaware, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, New Jersey, New Mexico, Rhode Island, Vermont, Wisconsin, and the District of Columbia, as well as the governor of Pennsylvania.

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