21 states sue over Trump’s attacks on gender-affirming care insurance coverage

Nearly two dozen Democratic-led states sued the Trump administration Wednesday over a new rule barring federal Medicaid funding for gender-affirming care for transgender youth.

The lawsuit, filed Tuesday in federal court in Massachusetts, challenges a rule the Centers for Medicare & Medicaid Services issued last month barring states from using federal Medicaid or Children’s Health Insurance Program funds for what the agency calls “experimental and life-altering sex-rejecting procedures.”

But the coalition of 21 states and Washington, D.C., alleges that CMS exceeded its legal authority by excluding otherwise lawful medical treatments from federal reimbursement.

Related: Transgender federal workers sue Trump administration over insurance ban on their health care

“Contrary to Congress’s clear directive, the Rule strips the states of their statutorily authorized role as Medicaid and CHIP administrators, usurps the states’ medical necessity determinations, and permits the federal government to unilaterally prohibit federal financial participation (“FFP”) or reimbursement for certain types of healthcare treatments and services,” the complaint states, “only when those treatments and services are provided to transgender adolescents. Congress has never empowered Defendants to do so.”

Attorneys general from California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New York, Oregon, Rhode Island, Vermont, Virginia, Washington and Wisconsin filed the lawsuit alongside Washington, D.C., and Pennsylvania Gov. Josh Shapiro.

Administration officials have characterized gender-affirming care as experimental, despite the American Medical Association, the American Academy of Pediatrics and other leading medical organizations supporting access to the care and opposing government restrictions on it.

Related: Republican states join Trump FTC in lawsuit against world’s leading transgender health care group

CMS Administrator Mehmet Oz defended the rule.

“Children deserve our protection, not experimental interventions that pose serious risks and convey no proven benefits,” Oz said. “By cutting off federal funds for these sex-rejecting procedures, we’re following the science, saving taxpayer dollars, and, most importantly, protecting children from potentially irreversible harm so they can truly flourish.”

The lawsuit names Oz, Health and Human Services Secretary Robert F. Kennedy Jr., HHS, and CMS as defendants.

The complaint notes that the administration tried last year to restrict access to gender-affirming care nationwide through administrative guidance, but a federal judge struck that effort down in April. U.S. District Judge Mustafa T. Kasubhai vacated the “Kennedy Declaration,” finding that it exceeded HHS’s authority, violated federal rulemaking requirements and conflicted with existing law.

The coalition argues that the administration is now trying to impede care by financially punishing states.

“Defendants have taken their campaign one step further by unilaterally banning federal reimbursement for many forms of transgender healthcare for adolescents,” the lawsuit contends. “Their strategy threatens the foundation of the Medicaid system and grossly oversteps the statutory authority provided by Congress.”

Democratic officials across the country said courts must stop what they described as federal overreach.

Related: Lawsuit challenges Trump's executive order targeting gender-affirming care

“The federal government does not have the authority to dictate what medically necessary care New York provides to its residents,” said New York Attorney General Letitia James. “This unlawful rule threatens access to health care for transgender young people and undermines states’ ability to administer our own Medicaid programs. New York will continue to stand up for patients and defend our authority to provide the care they need.”

Massachusetts Attorney General Andrea Joy Campbell added, “The Trump Administration’s latest attack on access to gender-affirming care for young people unlawfully undermines states’ authority to regulate healthcare and tries to strip healthcare access from vulnerable kids. Gender-affirming care remains legal and protected in Massachusetts, and we will not allow the federal government to dictate what care our patients receive. I will continue to challenge these unlawful actions and use every tool at my disposal to defend the rights of transgender young people and their families.”