Federal Judge Issues Decision Thwarting the Trump Administration’s Efforts to Curtail Gender-Affirming Care for Minors

As discussed in our prior Alert, Judge Mustafa Kasubhai of the United States District Court for the District of Oregon heard summary judgment oral arguments on March 19, 2026 regarding a declaration issued by the Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. (the “Kennedy Declaration”). On April 18, 2026, Judge Kasubhai issued his order and opinion, granting the motion for summary judgment filed by 19 states and the District of Columbia (“Plaintiff States”) and denying the motion to dismiss filed by Secretary Kennedy, HHS’s Office of Inspector General (OIG), and HHS (the “Defendants”).

In his April 18, 2026 opinion, Judge Kasubhai ruled in favor of the Plaintiff States on all counts. As a threshold matter, he determined that the Kennedy Declaration was “unquestionably” final agency action and ripe for adjudication. On the merits, Judge Kasubhai identified three independent bases for relief.  First, he held that the Defendants violated the Administrative Procedure Act (APA) and the Medicare Act because the Kennedy Declaration created a new legally binding standard of care without undergoing required notice and comment rulemaking. Second, HHS exceeded its statutory authority by purporting to dictate professionally recognized standards of medical care, expressly superseding state standards of care. Third, the Kennedy Declaration violated the terms of federally approved state Medicaid plans that cover gender-affirming care (GAC) and was therefore not in accordance with the law.

The Court then granted three forms of relief. First, it vacated the Kennedy Declaration in its entirety. Second, it issued a declaratory judgment that Defendants lack the authority to unilaterally establish standards of care that supersede professionally recognized standards of care for provision of GAC in the Plaintiff States. Third, the Court permanently enjoined Defendants, their officers, agents, services, and attorneys, including those at the Office of the Inspector General (HHS-OIG), “from initiating enforcement action, enforcing, implementing, giving intent to, or relying, in whole or in part, on the Kennedy Declaration—or any materially similar policy which supersedes or purports to supersede the professionally recognized standards of care for gender-affirming care that exist in the Plaintiff States—against any provider in the Plaintiff States.” Judge Kasubhai’s decision underscores the important role courts are playing in defining the balance of legal authority between the states and the federal government.