A federal judge in Oregon has ruled against the Trump administration’s decision to end all federal funding for providers that offer gender-affirming care, saying Health Secretary Robert F. Kennedy Jr. had sowed “chaos and terror.”
The blistering opinion issued Saturday by Judge Mustafa Kasubhai in U.S. District Court in Eugene said a December declaration by Kennedy proposing to pull Medicare and Medicaid funding from hospitals and clinics that offer gender-affirming care had harmed children and was cruel and unlawful.
“This case illustrates that when a leader acts without authority and in the absence of the rule of law, he acts with cruelty,” Kasubhai wrote.
The case centers on a December notice issued by Kennedy contending that gender-affirming care — which includes puberty blockers, hormones and surgery — causes young people “irreversible harm.”
Withdrawing funding would have a devastating effect on providers serving low-income people on Medicaid or the elderly and those with disabilities who have Medicare and also offer gender-affirming care. Nearly all U.S. hospitals participate in Medicaid and Medicare, which serve nearly 140 million nationwide. They include 2.4 million people in Oregon, where one in three people are on Medicaid.
Kasubhai’s ruling prevents the administration from moving forward for now, though the Trump administration is likely to continue its campaign against what it calls “sex-rejecting procedures.”
It has taken several actions to restrict gender-affirming care, including an order in January 2025 that told the government to cut funding for gender-affirming care for people under 19. The administration has also called for investigating providers and removing coverage for gender-affirming care from federal employee health plans.
“Under my leadership, and answering President Trump’s call to action, the federal government will do everything in its power to stop unsafe, irreversible practices that put our children at risk,” Kennedy said in his December statement.
Emily Hilliard, senior press secretary for the U.S. Department of Health and Human Services, declined to comment Monday on the judge’s decision, but indicated to The Lund Report that the agency will take further action.
“HHS will continue to fight to protect our nation’s children, as this Biden-appointed judge’s ruling puts radical ideology ahead of their safety,” Hilliard said in an email.
Kasubhai, who was confirmed by the Senate in 2024 despite Republican objections, blasted Kennedy in his opinion. He rebuked the secretary’s “utter failure” to follow appropriate procedures and said the federal official had issued a declaration “by fiat” that “harmed children.”
“Secretary Kennedy’s utter failure to promulgate rules in accordance with statutory authority, but instead threaten to cease federal funding to medical providers almost immediately after the declaration, caused chaos and terror for all those people and institutions of our great nation,” Kasubhai wrote.
Eight days after the declaration, Health and Human Services referred Seattle Children’s Hospital to the Office of the Inspector General for exclusion from Medicaid for failing to meet professionally recognized standards of health care. It referred 11 more children’s hospitals for exclusion in January, and in February touted that “more than 30 hospitals and hospital systems” had stopped providing gender-affirming care to minors, Kasubhai said in his opinion.
“Tragically, this case is one of a long list of examples of how a leader’s wanton disregard for the rule of law causes very real harm to very real people,” Kasubai said.
Oregon welcomes decision
Oregon’s attorney general, who led a coalition of 21 Democratic states and the District of Columbia in suing Kennedy over the declaration, welcomed Kasubhai’s decision.
“The freedom to make personal health care decisions — with your family and your doctor – is a fundamental Oregon value,” Rayfield said in a statement. “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.”
In their complaint, the states’ coalition said the December notice marked the first time the Department of Health and Human Services had issued a categorical rejection of a medical intervention.
“HHS has never before issued a “declaration” or other sub-regulatory guidance document purporting to apply a categorical definition of ‘safety and effectiveness’ to any medical intervention,” the complaint said.
In court filings, U.S. lawyers tried to downplay the importance of Kennedy’s December declaration, saying it merely reflected his opinion on the safety of gender-affirming care and was not binding.
Kasubhai rejected that argument.
“Defendants’ jurisdictional arguments are based on the bald-faced lie that the Kennedy declaration amounts to nothing more than one man’s musings on gender-affirming care,” Kasubhai wrote, saying the administration was trying to “gaslight it” into believing that gender-affirming care falls below professional standards.
He said the government was trying to replace one standard of care with another, calling that illegal. He said Medicare statutes clearly prohibit “any federal interference” that restricts medical treatments.
Kasubhai’s ruling in favor of the states centered on the manner in which Kennedy announced the policy without going through proper notice and rulemaking.
“The secretary has no legal authority to substantively alter the standards of care and effectively ban, by fiat, an entire category of health care,” Kasubhai said. “Nor does the secretary have authority to threaten providers’ participation in federal programs, including reimbursement by Medicare and Medicaid, by fiat.”
Trump administration officials say the use of drugs or surgery to align a child’s body with their gender identity leads to “irreversible damage, including infertility, impaired sexual function, diminished bone density, altered brain development and other irreversible physiological effects.”
But professional groups say this care is appropriate and even essential for youth who don’t identify with their sex at birth. It has wide backing from medical professionals, including the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American Medical Association and the American Psychological Association, the coalition argued.
“Research and clinical data support gender-affirming care as a safe and effective treatment for gender dysphoria in adolescents,” the complaint said. “Patients receiving gender-affirming care have high rates of satisfaction and low incidence of regret compared with other medical treatments.”
On the other hand, it said denying such care to youth could be devastating, leading to a range of problems, from anxiety and depression to substance abuse and self-harm.
“For many patients, medically necessary gender-affirming care is life-saving,” the complaint said.
It said the federal government gives states “substantial discretion” in deciding how to use Medicaid funds and has long reimbursed gender-affirming care for minors and adults on the Oregon Health Plan, the state’s version of Medicaid. It added that Washington state receives “millions of dollars annually” in reimbursements for treatment through Apple Health, its Medicaid program.
Along with Oregon and Washington, the plaintiffs included California, Colorado, Connecticut, Delaware, the District of Columbia, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, Rhode Island, Vermont, Wisconsin and Pennsylvania.
