AG Brown co-leads multistate challenge to federal attack on gender-affirming care

Attorney General Nick Brown is co-leading a multistate coalition of 19 other states suing to make clear that Secretary Robert F. Kennedy, Jr., 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.

Kennedy's declaration falsely claims that certain forms of gender-affirming care are "unsafe and ineffective" and threatens to punish doctors, hospitals, and clinics that continue to provide it with exclusion from the federal Medicare and Medicaid programs. Brown and the coalition argue 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. The coalition is asking the court to set aside the unlawful declaration.

"The law does not change on one man's whim, and this care remains legal under federal and state law. The administration is stigmatizing young people and unlawfully trying to rob them of care that is lifesaving in some instances," Brown said. "This action is as cruel and unnecessary as it is illegal, but consistent with an administration that puts politics above health."

On December 18, HHS published a document the agency called a "declaration," In the declaration, Secretary Kennedy claimed to give HHS the power to exclude health care providers and institutions from the Medicare and Medicaid programs simply for providing medically necessary health care for transgender adolescents. 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. The proposed rules have not yet gone into effect, and HHS has given the public until February 17, 2026, to submit comments on the proposals.

Brown 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. Instead, 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 contend that this is a clear overreach by the federal government, given that HHS does not have the authority to take such an action. For generations, states-not the federal government-have been responsible for regulating the practice of medicine. 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.

Gender-affirming care is lawful and protected in Washington. These actions threaten to exclude up to nearly 6,000 distinct providers throughout the state who offer gender-affirming care through the Apple Health program.

For transgender youth and their families, it creates immediate fear and uncertainty about whether ongoing care could suddenly be taken away. For doctors and hospitals, it threatens severe penalties simply for treating their patients with evidence-based, medically necessary care. For states, it puts Medicaid programs at risk - programs that millions of people depend on for everyday and lifesaving care. States rely on broad networks of providers to deliver essential health services. 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. This pressure would reduce access to care, worsen provider shortages, and harm Medicaid patients far beyond those seeking gender-affirming care.

Brown and the coalition are asking the court to rule the HHS declaration unlawful to stop its enforcement.

The attorneys general of Oregon and New York are co-leading the lawsuit with Washington. They are joined by the attorneys general of California, Colorado, Connecticut, Delaware, the District of Columbia, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, New Jersey, New Mexico, Rhode Island, Vermont, and Wisconsin, and the governor of Pennsylvania.

In a lawsuit filed earlier this year, Brown successfully obtained an injunction blocking President Trump's executive orders that threatened to withhold federal funding from medical institutions providing gender-affirming care to young people.

A copy of the complaint is available here.