Maryland AG Joins Lawsuit Against Federal Rule Restricting Gender-Affirming Care for Minors

Maryland Attorney General Anthony G. Brown is part of a coalition of 22 states challenging a recent federal rule that aims to prevent states from utilizing federal Medicaid funds for gender-affirming care for low-income transgender minors and young adults. The lawsuit contends that the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) overstepped their authority by enacting this rule, which the states argue lacks a valid basis.

The coalition’s legal challenge asserts that for decades, the Medicaid and Children’s Health Insurance Program (CHIP) have operated under a framework where states have the discretion to decide which services to cover, with limitations set by federal statute. The lawsuit argues that the federal agencies are now attempting to override the individualized medical decisions made by healthcare providers and the discretion of state Medicaid agencies. Instead, the federal agencies are unilaterally excluding medically necessary healthcare for transgender adolescents from federal reimbursement. This action by HHS and CMS is seen by the coalition as an unwarranted intrusion into state-level healthcare decisions, particularly when the same treatments are covered for non-transgender youth.

The challenged rule, proposed in December 2025, sought to prohibit federal reimbursement for gender-affirming care for Medicaid beneficiaries under 18 and CHIP beneficiaries under 19. Despite a significant public outcry, with over 90% of the more than 30,000 public comments opposing the proposal, HHS finalized the rule earlier this month, with an effective date of October 13, 2026. The coalition argues that this rule sets a dangerous precedent, allowing the executive branch to substitute its own policy preferences for the judgment of licensed medical professionals without explicit congressional authorization.

Furthermore, the coalition argues that the federal rule is inconsistent with various federal and state laws, and violates the Administrative Procedure Act and the Spending Clause of the U.S. Constitution. This legal action follows a pattern of what Attorney General Brown describes as “relentless attacks” on transgender youth by the Trump administration, particularly concerning healthcare access. Attorney General Brown has previously taken action to protect access to gender-affirming care for transgender youth in Maryland, including challenging federal actions that threatened providers, opposed efforts to remove protections for gender-affirming care under the Affordable Care Act, and spoken out against federal rules that could have jeopardized funding for hospitals serving transgender minors.

The states joining Maryland in this lawsuit include California, Colorado, Connecticut, Delaware, the District of Columbia, Hawaiʻi, Illinois, Maine, Michigan, Minnesota, Massachusetts, Nevada, New Jersey, New York, Oregon, Rhode Island, Vermont, Virginia, Washington, and Wisconsin. The governor of Pennsylvania also joined the coalition. This collaborative effort underscores the significant opposition from multiple states to the federal government’s attempt to restrict access to essential healthcare for a vulnerable population. Residents in participating states may see continued access to these services, but the ongoing legal battle highlights the uncertainty surrounding federal funding for such care.

Article by Mel Anara, based upon information from the Maryland Attorney General’s Office

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