A federal judge has issued a sweeping written order formally vacating HHS Secretary Robert F. Kennedy Jr.’s declaration on gender-affirming care for minors and permanently barring the administration from implementing any similar policy against healthcare providers in 21 states.
Four things to know:
1. Judge Mustafa Kasubhai of the U.S. District Court for the District of Oregon issued the 49-page opinion and order April 18. The opinion comes a month after Mr. Kasubhai issued a verbal ruling from the bench that Mr. Kennedy exceeded his legal authority when he issued the December declaration threatening to strip federal funding from hospitals that provide gender-affirming care to minors.
2. The written order formalizes that ruling and answers a key question that lingered after the March verbal decision: whether the court would go beyond striking down the declaration itself to block the administration from pursuing similar policies through other means. Mr. Kasubhai issued a permanent injunction blocking HHS from enforcing the declaration or any materially similar policy against the hospitals in 21 Democrat-led states and Washington, D.C., which filed the original lawsuit in December. The plaintiff states were Oregon, Washington, New York, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, Pennsylvania, Rhode Island, Vermont and Wisconsin.
3. In his rationale for issuing the injunction, Mr. Kasubhai cited the administration’s “significant and troubling history of evading or flouting prior court orders.” Given this record, the judge said, a declaratory judgment alone — which carries no direct enforcement mechanism — was insufficient. The judge also said HHS rested its arguments on a “bald-faced lie” by repeatedly characterizing Mr. Kennedy’s declaration as a nonbinding personal opinion with no legal consequences.
“Citing the Kennedy declaration, defendants have exploited the threat of exclusion to bully healthcare providers into suspending gender-affirming care they would otherwise provide in compliance with statewide standards of care out of fear they will lose federal healthcare program funding and the attendant ability to provide any life-saving care to all children,” he wrote in the opinion.
4. The ruling removes one layer of legal risk for hospitals operating in states where gender care remains legal at the state level. However, it does not resolve the broader regulatory uncertainty entirely. The injunction does not apply to healthcare organizations in the remaining 29 states, nor does it address the separate proposed CMS rules that would end Medicare and Medicaid payments to hospitals providing gender-affirming care to minors. These proposed rules remain a pending threat for healthcare providers regardless of where they operate.Editor’s note: Becker’s has reached out to HHS for comment and will update this article if more information becomes available.
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