Judge Strikes Down RFK Jr.'s Directive on Minors' Medicaid Gender Care

Federal Judge Mustafa T. Kasubhai in Eugene, Oregon, invalidated a December 18, 2025, declaration by Health and Human Services Secretary Robert F. Kennedy Jr. on Saturday, April 18, 2026. The declaration had stated that gender-affirming care for minors falls below healthcare standards for hospitals and threatened to terminate Medicaid and Medicare funding for providers offering it.

Kasubhai's ruling came in a lawsuit filed by 19 states, including California, and the District of Columbia, which argued the declaration bypassed required legal procedures for withdrawing federal funds. He rejected the government's term 'sex-rejecting procedures' for the care, opting instead for 'gender-affirming care' to ensure dignity in court proceedings.

The judge noted that Kennedy's estimate indicated more than 30 hospitals and hospital systems ceased providing gender-affirming care to minors after the declaration's publication, primarily due to fears of losing critical funding.

Providers faced a choice between halting services or risking financial collapse, Kasubhai wrote, as the declaration demanded immediate compliance without following statutory procedures for fund termination. He criticized the Trump administration's approach as one of 'break it and see if they can get away with it,' pointing to repeated violations of court orders.

Kennedy's action built on President Trump's January 28, 2025, executive order, which accused medical professionals of 'maiming and sterilizing' children through gender-affirming interventions like puberty blockers, hormone treatments, and surgery.

Trump's order directed agencies, including Health and Human Services, to investigate federally funded providers of such care and explore using Medicaid and Medicare rules against them. More than 20 hospitals and health systems suspended or rolled back transgender services for minors following the order.

Children's Hospital of Los Angeles terminated all gender-affirming services for minors in July 2025, citing threats to its ability to serve hundreds of thousands of patients.

Some institutions adjusted services to avoid full termination. Kaiser Permanente and Stanford Medicine ceased surgical interventions for minors but continued puberty blockers and hormone treatments, aligning with state laws and medical standards. 1 per 100,000 for ages 13 or 14, and zero for those 12 or younger.

The researchers concluded that low surgery rates reflect adherence to stringent medical standards, suggesting concerns about high usage among minors may be unwarranted. Children's Hospital Colorado suspended gender-affirming services in January 2026, a decision upheld by a state judge but under review by the Colorado Supreme Court.

At a prior hearing, a Rady Children's Health lawyer informed Braner that the system faced 'catastrophic risk' from potential funding loss. Braner acknowledged the dilemma, stating, 'You are between a rock and a hard place. The Department of Justice issued subpoenas last year to more than 20 doctors and clinics seeking evidence of healthcare fraud related to gender-affirming care.

S. policy shifts.

On peptides oversight, the Food and Drug Administration moved substances like BPC-157 and GHK-Cu to Category 2 status in 2023, prohibiting compounding due to safety concerns and lack of clinical trial data. Knoepfler wrote that the change, allowing specialty pharmacies to resume compounding and marketing, poses major public health risks given the unproven nature of the peptides.