Government's Expanding Attack on Gender-Affirming Care Published in Health Affairs Forefront

For health care executives, compliance officers, and providers managing federal and state regulatory risk, the regulatory landscape around gender-affirming care is shifting dramatically—moving far beyond pediatric medicine into adult care and creating substantial liability exposure for organizations at every level of the health care system.

In a recent article published by Health Affairs Forefront, Richard H. Hughes IV, Eric J. Neiman, Jennifer M. Nelson Carney, and Julia Rioux Thayer of Epstein Becker Green examined how the administration's campaign against gender-affirming care is moving beyond pediatric medicine into adult care, creating new compliance and litigation risks for health care organizations of all types.

The regulatory assault on gender-affirming care operates through multiple federal mechanisms. Through grant conditions, enforcement threats, federal program exclusion actions, and agency communications, the federal government is using the machinery of health care funding and oversight to chill, restrict, and delegitimize adult gender-affirming care. The Ryan White HIV/AIDS Program—historically used to provide comprehensive care including gender-affirming services to transgender people living with HIV—has become a test case. The administration conditioned funding on compliance with Title IX as interpreted through executive orders framing gender identity as a threat to women. This framework transforms contested policy positions into funding requirements tied to False Claims Act exposure and criminal consequences.

The strategy extends beyond direct funding restrictions. Federal agencies have removed or restricted gender-affirming care from federal employee health programs regardless of age, curtailed access in federal prisons, eliminated sexual orientation and gender identity measures from federal data systems, and removed relevant public health information from agency websites. State governments are following the federal lead, restricting gender-affirming care for both minors and adults through Medicaid exclusions and other state-level restrictions. The result is a legal environment where providers face conflicting state and federal mandates, escalating litigation exposure, and growing institutional uncertainty.

The distinction between prohibiting gender-affirming care for minors and restricting care for adults is no longer holding. The campaign began with children. It is not stopping there.

Get in Touch

To discuss how your organization might navigate emerging legal and compliance challenges around gender-affirming care, contact:

• Richard H. Hughes IV, counsel to health care clients on health policy and government enforcement
• Eric J. Neiman, counsel to health systems on regulatory compliance and crisis management
• Jennifer M. Nelson Carney, counsel to hospitals on provider operations and compliance
• Julia Rioux Thayer, counsel to health care organizations on health care litigation and administrative law