A federal judge in Oregon on Saturday forcibly rejected Health and Human Services Secretary Robert F. Kennedy Jr.’s attempt to impose broad restrictions on gender-affirming care for minors, ruling that the policy was illegal and blocking implementation in states that challenged it.
in final judgment On April 18, U.S. District Judge Mustafa T. Kasbai invalidated the so-called Kennedy Declaration, finding that it exceeded the administration’s authority, violated federal rulemaking requirements, and conflicted with existing law.
The ruling is a harsh rebuke of one of the Trump administration’s most aggressive efforts to reshape transgender health care policy through presidential action alone.
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The court held that federal authorities “lack the authority to unilaterally establish standards of care” for gender-affirming treatment and cannot exclude health care providers from Medicare or Medicaid who provide care consistent with accepted medical guidelines. Judge Kasbai also permanently enjoined the federal government from enforcing the declaration or similar policies against providers in the plaintiff states, and ordered the agency to cease enforcement and notify authorities within seven days.
A powerful opening
The opinion began with unusually blunt language, arguing that the case was a far-reaching test of the rule of law.
“Unserious leaders are dangerous, and nothing is more serious than a leader’s commitment to the rule of law to maintain the integrity of a constitutional democracy,” Kasbai wrote.
“This case highlights leaders’ lack of regard for the rule of law,” the judge continued, adding that such disregard “doesn’t just result in abstract violations” but “causes very real harm to very real people.”
Kasbai said the court’s role is to assess not only the outcome of policy, but also whether the government followed the law when making policy. “They can and do judge the legality of the process (or lack thereof) by which policy choices are made,” he said.
The opinion harshly criticized the policy development, noting that President Kennedy “illegally issued a proclamation threatening to reduce federal funding” to health care providers and failed to follow required rulemaking procedures.
Had the administration acted lawfully, the judge wrote, “there may have been ample time and opportunity” for health care providers, families, and children — “all the people and institutions of our country” — to adjust or explore alternatives. Rather, the sudden threat of enforcement “caused confusion and fear among all the people and institutions of our country.”
The lawsuit centers on a December 2025 directive in which President Kennedy declared gender-affirming care for minors to be “neither safe nor effective” and warned that providers could be cut off from federal health programs. The declaration was part of a broader push by the Trump administration that included proposals from Medicare and Medicaid Services Administrator Mehmet Oz and others to strip federal funding from hospitals that provide such care to transgender youth and bar them from full Medicaid and CHIP coverage.
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Experts warned at the time that the administration’s approach was likely illegal. “They’re trying to do something that CMS simply doesn’t have the authority to do,” said a former senior official at the Centers for Medicare and Medicaid Services in the Biden administration. defendernoted that federal law prohibits government agencies from regulating medical practices. “There is no authority they cite for these acts.”
The court agreed with the policy, finding that it was issued without the notice-and-comment rulemaking required by the Administrative Procedure Act and improperly sought to replace established standards of care.
The pressure had an immediate effect. In the weeks after the policy was announced, hospitals across the country suddenly began scaling back or discontinuing treatment for transgender youth, and dozens of health systems suspended treatments such as puberty blockers and hormone therapy over concerns about losing federal funding or facing investigations.
Plaintiffs argued that the directive interfered with the agency’s authority to regulate medicines and threatened access to health care protected by state law, including Medicaid coverage of gender-affirming treatments.
Advocates react
LGBTQ+ advocates were quick to praise the decision. Equality California Executive Director Tony Huang said the ruling confirms that the federal government cannot circumvent laws that target transgender youth.
“‘Unserious leaders are dangerous,’ a federal judge wrote in today’s ruling,” Huang said in a statement. Defender. “This ruling confirms what we have said all along: The federal government cannot ignore the law and sacrifice people’s lives to advance its political agenda.”
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Huang called the policy “dangerous and illegal” and threatened to strip funding from providers and put transgender youth and their families “at risk of losing access to medically necessary evidence-based care.” He also praised California Attorney General Rob Bonta, who participated in the multi-state lawsuit that led to the decision.
High stakes for healthcare providers and patients
Federal authorities began acting on the proclamation within days of its publication, referring hospitals and health systems for possible exclusion from Medicare and Medicaid, according to court records. The court noted that the fine could serve as an “economic death sentence” for health care providers that rely on federal funding.
The declaration has the potential to reshape access nationwide by classifying gender-affirming care outside of “professionally recognized standards.” The court’s decision restores the status quo to the plaintiff states and allows health care providers to continue providing care without fear of losing federal funding.
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Gender-affirming care is considered safe, effective, and evidence-based and is supported by major medical associations such as the American Medical Association and the American Academy of Pediatrics.
broader legal battle
The lawsuit was brought by a coalition of states led by Oregon and including California, New York and Washington, all of which maintain policies that protect minors’ access to gender-affirming care.
The Trump administration is expected to appeal. But for now, the decision represents a significant legal setback for efforts to restrict transgender health care through federal executive action and a meaningful victory for states, health care providers, and advocates defending access to health care.
“Secretary Kennedy’s unlawful declaration harmed children,” Kasbai wrote. “This case shows that when leaders act without authority and without the rule of law, they commit brutal acts.”
Source: Advocate.com – www.advocate.com
