Federal judge unloads on ‘unserious’ RFK Jr., says anti-trans policy showed his ‘cruelty’

A federal judge in Oregon on Saturday forcefully struck down Health and Human Services Secretary Robert F. Kennedy Jr.’s attempt to impose far-reaching restrictions on gender-affirming care for minors, ruling the policy unlawful and blocking its enforcement in the states that challenged it.

In a final judgment dated April 18, U.S. District Judge Mustafa T. Kasubhai vacated the so-called "Kennedy Declaration," finding it exceeded the administration’s authority, violated federal rulemaking requirements, and conflicted with existing law.

The ruling delivers a sharp rebuke to one of the Trump administration’s most aggressive efforts to reshape transgender health care policy through executive action alone.

Related: RFK Jr. and Dr. Oz announce sweeping measures to ban gender-affirming care for trans youth

The court held that federal officials "lack the authority to unilaterally establish standards of care" for gender-affirming treatment and cannot exclude providers from Medicare or Medicaid for offering care consistent with accepted medical guidelines. Judge Kasubhai also permanently enjoined the federal government from enforcing the declaration or any similar policy against providers in the plaintiff states, ordering agencies to halt enforcement and notify officials within seven days.

A forceful opening

The opinion opened with unusually blunt language, calling out the case as a broader test of the rule of law.

“Unserious leaders are unsafe. There is nothing more serious than our leaders’ dedication to the rule of law so that we might maintain the integrity of our constitutional democracy,” Kasubhai wrote.

“This case highlights a leader’s unserious regard for the rule of law,” the judge continued, adding that such disregard “does not merely result in an abstract infraction” but “causes very real harm to very real people.”

Kasubhai said the court’s role was to evaluate not just policy outcomes but whether the government followed the law in creating them, writing that it “can and does judge the lawfulness of the process (or lack thereof) by which any policy choice might be made.”

The opinion sharply criticized the policy's rollout, noting that Kennedy “unlawfully issued a declaration threatening to cut federal funding” to medical providers and failed to follow required rulemaking procedures.

If the administration had acted lawfully, the judge wrote, “there might have been ample time and opportunity” for providers, families, and children — “all people and institutions of our great nation” — to adjust or seek alternatives. Instead, the abrupt threat of enforcement “caused chaos and terror for all those people and institutions of our great nation.”

The case centers on a December 2025 directive in which Kennedy declared gender-affirming care for minors “neither safe nor effective” and warned that providers could be cut off from federal health programs. The declaration was part of a broader push by the Trump administration, including proposals from Centers for Medicare and Medicaid Services Administrator Mehmet Oz, to strip federal funding from hospitals providing such care to transgender youth and bar Medicaid and CHIP from covering it entirely.

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Experts had warned at the time that the administration’s approach was likely unlawful. “They are trying to do something that CMS simply isn’t empowered to do,” a former senior Centers for Medicare & Medicaid Services official from the Biden administration told The Advocate, noting that federal law bars the agency from regulating the practice of medicine. “The authority that they are citing for these actions does not exist.”

The court agreed, finding the policy was issued without the notice-and-comment rulemaking required under the Administrative Procedure Act and that it improperly attempted to supersede established standards of care.

The pressure had immediate effects. In the weeks after the policy was announced, hospitals across the country began abruptly scaling back or halting care for transgender youth, with dozens of health systems pausing treatments such as puberty blockers and hormone therapy amid fears of losing federal funding or facing investigation.

Plaintiffs argued that the directive interfered with their authority to regulate medicine and threatened access to care protected under state law, including Medicaid coverage for gender-affirming treatment.

Advocates respond

LGBTQ+ advocates were quick to praise the decision. Equality California Executive Director Tony Hoang said the ruling confirms that the federal government cannot circumvent the law to target transgender youth.

"'Unserious leaders are unsafe,' a federal judge wrote in today's decision," Hoang said in a statement to The Advocate. "This ruling confirms what we have said all along: the federal government cannot ignore the law to push a political agenda at the expense of people’s lives."

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Hoang called the policy “dangerous and unlawful," saying it threatened to strip providers of funding and put transgender young people and their families “in harm’s way by threatening access to medically necessary, evidence-based healthcare." He also credited California Attorney General Rob Bonta for joining the multistate lawsuit that led to the ruling.

High stakes for providers and patients

Court records show federal officials began acting on the declaration within days of its release, referring hospitals and health systems for potential exclusion from Medicare and Medicaid. The court noted that the penalty can function as a "financial death sentence" for providers reliant on federal funding.

By classifying gender-affirming care as outside "professionally recognized standards," the declaration could reshape access nationwide. The court’s ruling restores the status quo in the plaintiff states, allowing providers to continue offering care without the threat of losing federal funding.

Related: Federal judge blocks RFK Jr. from limiting care for trans youth

Gender-affirming care has been deemed safe, effective, and evidence- based and is supported by major medical associations, including the American Medical Association and the American Academy of Pediatrics.

A broader legal battle

The lawsuit was brought by a coalition of states led by Oregon and including California, New York, Washington, and others — all of which maintain policies protecting access to gender-affirming care for minors.

The Trump administration is expected to appeal. For now, however, the decision marks a significant legal setback for efforts to restrict transgender health care through federal administrative action and a meaningful victory for the states, providers, and advocates defending access to care.

"Secretary Kennedy’s unlawful declaration harmed children,” Kasubhai wrote. “This case illustrates that when a leader acts without authority and in the absence of the rule of law, he acts with cruelty."