
Judge Mustafa Kasubhai has ruled that Health and Human Services Secretary Robert F. Kennedy, Jr. overstepped his authority by trying to restrict hospitals from providing gender-affirming care to transgender minors. He found that Kennedy failed to follow required administrative procedures when issuing a declaration last December claiming such care does not meet accepted medical standards.
The so-called “Kennedy declaration” accompanied an HHS announcement proposing two rules aimed at restricting gender-affirming care for transgender minors.
Proposed by the Centers for Medicare and Medicaid Services, the rules would bar federal Medicaid funds from covering transition-related care for transgender youth under 19 and strip federal funding from hospitals that provide gender-affirming care to minors.
The rules, which would likely face legal challenges, required a public comment and review period before the finalized versions of them can be released. The declaration, by contrast, would have allowed the Trump administration to act more rapidly and target individual private providers and community health centers that rely on federal programs to cover a larger part of the cost of patient care.
Twenty-one Democratic-led states filed a lawsuit arguing that the declaration — which claimed it “supersedes” state and national standards of care — interfered with their authority to regulate the practice of medicine. They also argued that the federal government attempted to unilaterally establish a national medical standard in violation of the Administrative Procedure Act, which requires agencies to act within the authority delegated by Congress.
The Trump administration countered that the states failed to show harm from the declaration, noting that no providers of transition-related care have been barred from receiving Medicare or Medicaid. Government lawyers also characterized Kennedy’s declaration as a “non-binding policy position,” likening it to an opinion piece.
“The notion that ‘I will go forward and issue a declaration and see if we can get away with it’ is not a principle of governance that adheres to the overarching commitment to a democratic republic that requires the rule of law to be regarded and respected and honored as sacred,” Kasubhai wrote in his ruling.
Kasubhai also rejected the federal government’s motion to dismiss the case.
The decision marks a significant setback for the Trump administration and provides temporary relief to hospitals, clinics, and providers who treat minors for gender dysphoria.
“The freedom to make personal healthcare decisions — with your family and your doctor — is a fundamental Oregon value,” Democratic Oregon Attorney General Dan Rayfield said in a statement following the ruling. “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.”
“Politicians, including RFK Jr, do not get to tell doctors how to do their jobs or families what decisions are best for their children,” Kelley Robinson, the president of the Human Rights Campaign, said in a statement.
Equality California called the ruling a “major victory for health care providers across the country, affirming that they can and should continue providing care to transgender youth.”
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