Federal Pressure Shutters Pediatric Gender Clinics Nationwide
Rule Changes
HHS investigations and funding threats force hospitals to halt care even in states where it remains legal; California AG sues Rady for violating merger conditions
HHS investigations and funding threats force hospitals to halt care even in states where it remains legal; California AG sues Rady for violating merger conditions
Lurie Children's Hospital opened the Midwest's first pediatric gender identity clinic in 2013. Thirteen years later, it announced it will no longer prescribe gender-affirming medications to new patients under 18—days after HHS General Counsel Mike Stuart referred the hospital for federal investigation. Lurie joins at least 40 hospital systems that have paused or ended pediatric gender services since January 2025, including Rady Children's Health—California's largest pediatric healthcare system—which announced on January 23, 2026, it will stop all gender-affirming medical interventions on February 6. On February 3, California Attorney General Rob Bonta sued Rady for violating legally binding merger conditions that required the hospital to maintain gender-affirming care through 2034.
The administration's strategy bypasses state legislatures entirely. By threatening to exclude hospitals from Medicare and Medicaid—which provide 60-70% of revenue for many children's hospitals—HHS has effectively restricted care even in California, Illinois, and other states with protective laws. A coalition of 21 states has sued to block the policy, with oral arguments set for March 19, 2026. Until then, HHS has agreed not to formally exclude hospitals, but the investigations and proposed rules continue to drive voluntary compliance. The pressure has sparked legal pushback from multiple directions: families sued Children's Hospital Colorado on January 21 for discrimination under state law, California's AG sued Rady on February 3 for violating merger conditions, and a federal judge on January 12 ordered HHS to restore $12 million to the American Academy of Pediatrics, calling funding cuts "retaliatory."
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Key Indicators
40+
Hospitals pausing or ending care
Hospital systems that have paused, discontinued, or ended pediatric gender services since January 2025; at least 9 have stopped hormones and puberty blockers
15+
Hospitals under OIG investigation
Children's hospitals referred for HHS Inspector General investigation by General Counsel Stuart
21
States suing HHS
States plus D.C. challenging the Kennedy Declaration in federal court
27
States with existing bans
States that have enacted legislative bans on gender-affirming care for minors
People Involved
Robert F. Kennedy Jr.
Secretary of Health and Human Services (Leading federal effort to restrict pediatric gender care)
Mike Stuart
HHS General Counsel (Directing hospital investigation referrals; at least 15 hospitals referred to date)
Robert Garofalo
Founder, Lurie Children's Gender Development Program (Established Midwest's first pediatric gender clinic in 2013)
Organizations Involved
U.
U.S. Department of Health and Human Services (HHS)
Federal Agency
Status: Driving enforcement effort through declarations, investigations, and proposed rules
Federal agency overseeing Medicare, Medicaid, FDA, and CDC with approximately 90,000 employees.
AN
Ann & Robert H. Lurie Children's Hospital of Chicago
Children's Hospital
Status: No longer initiating gender-affirming medications for patients under 18
Chicago pediatric hospital that operated the first gender identity clinic in the Midwest since 2013.
AM
American Academy of Pediatrics
Medical Professional Organization
Status: Opposing federal restrictions, defending gender-affirming care as evidence-based
Organization of 67,000 pediatricians that has formally endorsed gender-affirming care as medically appropriate.
ST
State Attorney General Coalition
Multi-State Litigation Coalition
Status: Challenging Kennedy Declaration in federal court
Coalition of 21 states plus D.C. suing to block the HHS declaration as unlawful under the Administrative Procedure Act.
RA
Rady Children's Health
Healthcare System
Status: Ending all gender-affirming medical interventions effective February 6, 2026; under OIG investigation; sued by California AG for violating merger conditions
California's largest pediatric healthcare system, serving approximately 1,000 gender-diverse patients across San Diego, Orange County, and Riverside County.
Timeline
STAT Analysis: 40+ Hospitals Have Paused Gender-Affirming Care
Analysis
STAT News analysis finds at least 40 hospitals nationwide have paused or ceased gender-affirming care since January 2025; at least 9 have stopped hormones and puberty blockers. HHS General Counsel Stuart claims 30+ stopped 'in recent weeks' but does not name them.
California AG Sues Rady Children's Health Over Care Closure
Legal
California Attorney General Rob Bonta files lawsuit against Rady Children's Health for violating merger conditions requiring maintenance of gender-affirming care through 2034. Bonta seeks permanent injunction to restore services and civil penalties.
Rady Children's Hospital Announces End to Gender-Affirming Care
Hospital Action
California's largest pediatric healthcare system announces it will stop all gender-affirming medical interventions on February 6, affecting approximately 1,000 patients. Hospital reveals it is under HHS OIG investigation.
Lurie Halts New Gender-Affirming Medications for Minors
Hospital Action
Lurie Children's Hospital announces it will no longer prescribe gender-affirming medications to patients under 18 who have not previously been treated by their team.
Families Sue Children's Hospital Colorado for Discrimination
Legal
Parents of four transgender children (ages 9-17) file lawsuit in Denver District Court alleging the hospital's suspension of gender-affirming care violates Colorado's Anti-Discrimination Act.
Stuart Refers Six More Hospitals Including Lurie
Investigation
HHS General Counsel refers Lurie, Boston Children's, CHOP, Nemours, NYU Langone, and Doernbecher Children's Hospital for OIG investigation.
Federal Judge Orders HHS to Restore AAP Funding
Legal
U.S. District Judge Beryl Howell grants preliminary injunction restoring $12 million to American Academy of Pediatrics, finding HHS likely had "retaliatory motive" for December funding cuts.
States File for Summary Judgment
Legal
State coalition files motion for summary judgment; HHS agrees not to issue exclusion notices pending court decision or 30 days after March 19 oral argument.
Stuart Refers First Three Hospitals for OIG Investigation
Investigation
HHS General Counsel Stuart announces referral of Seattle Children's, Children's Hospital Colorado, and Children's Minnesota to OIG for investigation.
Children's Hospital Colorado Suspends Gender Care
Hospital Action
Following OIG referral, hospital announces it will not write new prescriptions or renew existing prescriptions for gender-affirming care for patients under 18.
19 States Sue to Block Kennedy Declaration
Legal
Coalition of Democratic-led states files Oregon v. Kennedy in federal district court, arguing HHS bypassed required rulemaking procedures.
HHS Secretary Kennedy declares gender-affirming care for minors unsafe and ineffective, threatens to exclude participating hospitals from Medicare and Medicaid.
CMS Proposes Rules Banning Hospital Participation
Regulatory
Two proposed rules would bar hospitals from Medicare/Medicaid for providing any gender-affirming care to minors, regardless of payment source. Comment period ends February 17, 2026.
Court Blocks DOJ Subpoena for CHOP Patient Records
Legal
U.S. District Judge Mark Kearney quashes DOJ subpoena seeking detailed medical records from Children's Hospital of Philadelphia, ruling it exceeded congressional authority.
Mike Stuart Confirmed as HHS General Counsel
Personnel
Former U.S. Attorney and West Virginia State Senator Mike Stuart confirmed to lead HHS legal office.
CHLA Gender Clinic Closes
Hospital Action
Children's Hospital Los Angeles shuts down one of the oldest and largest pediatric gender clinics in the country, leaving nearly 3,000 patients to find new providers.
Children's Hospital Los Angeles Announces Clinic Closure
Hospital Action
CHLA announces it will close its Center for Transyouth Health and Development on July 22, citing dependence on federal funding and 'no viable path forward.'
Federal Court Partially Blocks Executive Order
Legal
U.S. District Court issues partial injunction against enforcement of Executive Order 14187 in response to civil rights lawsuit.
Lurie Pauses Gender-Affirming Surgeries for Minors
Hospital Action
Lurie Children's Hospital suspends gender-affirming surgeries for patients under 19, while continuing hormone therapy and other services.
Civil Rights Groups Sue Over Executive Order
Legal
ACLU, Lambda Legal, and others file federal lawsuit challenging Executive Order 14187 as unconstitutional discrimination.
Trump Signs Executive Order on Pediatric Gender Care
Executive Action
Executive Order 14187, 'Protecting Children from Chemical and Surgical Mutilation,' directs agencies to restrict federal funding for gender-affirming care for individuals under 19.
Scenarios
1
Court Blocks Declaration, Care Resumes at Some Hospitals
Discussed by: Legal analysts at Reed Smith, Foley & Lardner; state attorneys general in litigation filings
The Oregon federal court grants summary judgment for the states, finding the Kennedy Declaration exceeded HHS statutory authority and violated Administrative Procedure Act requirements. With the immediate threat of Medicare/Medicaid exclusion lifted, hospitals in states without legislative bans gradually resume services, though some remain cautious pending appeal. The proposed CMS rules remain in limbo, awaiting finalization.
2
Rules Finalized, Care Disappears From Major Hospital Systems
Discussed by: Epstein Becker Green health law practice; Children's Hospital Association statements
The Oregon court upholds the Kennedy Declaration or the case stalls long enough for CMS to finalize the proposed rules. With participation in federal health programs now conditioned on not providing any pediatric gender care, virtually all major hospital systems exit the field. Care becomes available only through private practitioners and specialty clinics with minimal federal funding exposure. Access contracts sharply even in protective states.
3
Standoff Continues Through 2026 Election
Discussed by: STAT News political analysis; health policy scholars
Courts issue preliminary injunctions preventing enforcement while litigation proceeds through appeals. Neither side achieves decisive victory before November 2026. Hospitals remain in a gray zone—some maintaining care, others too risk-averse to continue. The issue becomes a midterm election flashpoint, with policy outcomes depending on congressional results.
4
Private Practice Networks Fill the Gap
Discussed by: Trans Up Front IL organizing efforts; NPR reporting on California private providers
Advocacy organizations accelerate efforts to connect patients with private practitioners less exposed to federal funding threats. Networks of independent physicians, often operating on cash-pay or private insurance models, absorb patients from shuttered hospital programs. Access becomes stratified by geography and income, with care remaining available but harder to find for lower-income families in many regions.
Historical Context
UK National Health Service Cass Review (2024)
April 2024
What Happened
Pediatrician Hilary Cass completed a four-year independent review of NHS gender services for young people. The report concluded that evidence for puberty blockers was 'weak' and recommended restricting their use to clinical trials. NHS England immediately decommissioned routine puberty blocker prescribing and closed the Tavistock gender clinic, replacing it with regional services under tighter protocols.
Outcome
Short Term
The UK government prohibited puberty blocker prescriptions for minors outside research settings. Thousands of young people on waiting lists faced indefinite delays.
Long Term
The Cass Review became a reference point for policymakers worldwide seeking to restrict pediatric gender care, though medical organizations in Germany, Austria, and elsewhere disputed its methodology and conclusions.
Why It's Relevant Today
HHS cited the Cass Review in its December 2025 declaration. The UK example shows how an official evidence review can enable rapid policy change—but also how contested the underlying science remains among medical bodies internationally.
Sweden and Finland Restrict Pediatric Gender Care (2020-2022)
2020-2022
What Happened
Finland's Council for Choices in Health Care concluded in 2020 that hormonal treatments for minors were experimental and should not be first-line care. Sweden followed in 2022, with the National Board of Health and Welfare finding that 'the risks of puberty blockers and gender-affirming treatment are likely to outweigh the expected benefits' and restricting treatments to research settings.
Outcome
Short Term
Both countries shifted to psychotherapy-first approaches. Access to medical interventions for minors dropped sharply, though a small number continued receiving care under research protocols.
Long Term
The Nordic reversals gave political cover to restriction advocates elsewhere, while supporters of gender-affirming care noted these countries did not ban care outright and continued legal gender recognition reforms.
Why It's Relevant Today
The European precedents demonstrate that restrictions can emerge from within national health systems rather than through legislative bans. The U.S. approach combines elements of both—executive regulatory action operating alongside state-level legislation.
Federal Family Planning Funding Restrictions (1988-2019)
1988-2019
What Happened
The Reagan administration's 1988 'gag rule' barred Title X family planning clinics from providing abortion referrals. Planned Parenthood and other providers faced a choice: comply and restrict counseling, or exit the federal program. The rule was rescinded by Clinton, reinstated by Trump in 2019, and rescinded again by Biden.
Outcome
Short Term
In both eras, major providers withdrew from Title X rather than comply, reducing access to federally-funded family planning services in many regions.
Long Term
The repeated reversals demonstrated how executive-branch funding conditions can reshape healthcare access without legislation—but also how such policies remain vulnerable to electoral change.
Why It's Relevant Today
The current HHS strategy mirrors the Title X approach: using participation in federal health programs as leverage to restrict specific services. The family planning precedent suggests hospitals may face pressure to exit federal programs or comply, with policy durability depending on future elections.
