{"id":654315,"date":"2025-08-15T07:00:49","date_gmt":"2025-08-15T11:00:49","guid":{"rendered":"https:\/\/www.kff.org\/?post_type=fact-sheet&#038;p=654315"},"modified":"2025-09-08T12:26:36","modified_gmt":"2025-09-08T16:26:36","slug":"overview-of-president-trumps-executive-actions-impacting-lgbtq-health","status":"publish","type":"post","link":"https:\/\/www.kff.org\/other-health\/overview-of-president-trumps-executive-actions-impacting-lgbtq-health\/","title":{"rendered":"Overview of President Trump\u2019s Executive Actions Impacting LGBTQ+ Health"},"content":{"rendered":"<div\n\tclass=\"no-sidebar wp-block-kff-shared-content--extra-wide wp-block-kff-shared-content\">\n\t\n\n<section class=\"wp-block-kff-shared-content-main\">\n\t\t\t<div class=\"post-header\">\n\t\t\t\t\t\n\t<h1 class=\"post-header__title\">Overview of President Trump\u2019s Executive Actions Impacting LGBTQ+ Health<\/h1>\n\n\t\n\t\t\t<div class=\"post-header__meta\">\n\t\t\t\t\t<div>\n\t\t\t\t<span class=\"post-header__meta-label\">\n\t\t\t\tAuthors:\t\t\t\t<\/span>\n\t\t\t\t<a href=\"https:\/\/www.kff.org\/person\/lindsey-dawson\/\">Lindsey Dawson<\/a> and <a href=\"https:\/\/www.kff.org\/person\/jennifer-kates\/\">Jennifer Kates<\/a> \t\t\t<\/div>\n\t\t\t\t<div>\n\t\t\t<span class=\"post-header__meta-label\">Published:<\/span>\n\t\t\t<date>Aug 15, 2025<\/date>\n\t\t<\/div>\n\t\t<\/div>\n\t\n\t<div class=\"post-header__social-sharing\">\n\t\t<button class=\"post-header__social-sharing__button print\">\n\t\t\t<svg width=\"16\" height=\"17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n\t\t\t\t<path d=\"M4.348 2.5v3.391H2.783A.787.787 0 0 0 2 6.674v4.696c0 .429.353.782.783.782h1.565V14.5h7.304v-2.348h1.565c.43 0 .783-.353.783-.782V6.674a.787.787 0 0 0-.783-.783h-1.565V2.5H4.348Zm.522.522h6.26v2.87H4.87v-2.87ZM2.783 6.413h1.782a.26.26 0 0 0 .085 0h6.697a.26.26 0 0 0 .086 0h1.784c.148 0 .261.114.261.26v4.697c0 .147-.113.26-.26.26h-1.566V9.283H4.348v2.347H2.783a.257.257 0 0 1-.261-.26V6.674c0-.147.113-.261.26-.261Zm9.39.783a.522.522 0 1 0 0 1.043.522.522 0 0 0 0-1.043ZM4.87 9.804h6.26v2.043a.264.264 0 0 0 0 .086v2.045H4.87v-2.043a.261.261 0 0 0 0-.085V9.804Zm1.043.783a.262.262 0 0 0-.265.26.26.26 0 0 0 .265.262h4.174a.26.26 0 1 0 0-.522H5.913Zm0 1.043a.26.26 0 1 0 0 .522h3.13a.26.26 0 1 0 0-.522h-3.13Zm0 1.044a.26.26 0 1 0 0 .522h4.174a.262.262 0 0 0 .264-.261.26.26 0 0 0-.264-.261H5.913Z\" fill=\"#004B88\" stroke=\"#004B88\" stroke-width=\".5\"\/>\n\t\t\t<\/svg>\n\n\t\t\tPrint\t\t<\/button>\n\t\t<a href=\"mailto:?subject=Overview%20of%20President%20Trump%E2%80%99s%20Executive%20Actions%20Impacting%20LGBTQ%2B%20Health&#038;body=https%3A%2F%2Fwww.kff.org%2Fother-health%2Foverview-of-president-trumps-executive-actions-impacting-lgbtq-health%2F\" class=\"post-header__social-sharing__button\">\n\t\t\t<svg width=\"16\" height=\"17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n\t\t\t\t<path d=\"M2.333 4.25h-.25v9.14h12.5V4.25H2.333Zm1.083 1.693-.353-.2V5.23h10.54v.513l-.353.2L8.333 8.73 3.416 5.943Zm-.353 6.467V6.884l.107.06 5.04 2.857.123.07.123-.07 5.04-2.857.107-.06v5.526H3.063Z\" fill=\"#004B88\" stroke=\"#004B88\" stroke-width=\".5\"\/>\n\t\t\t<\/svg>\n\n\t\t\tEmail\t\t<\/a>\n\t\t<button class=\"post-header__social-sharing__button copy\">\n\t\t\t<svg width=\"16\" height=\"17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n\t\t\t\t<path d=\"M11.533 2.9c-.615 0-1.23.235-1.697.702L8.502 4.936a2.4 2.4 0 0 0-.575 2.46l.958-.958a1.32 1.32 0 0 1 .371-.748l1.334-1.333a1.331 1.331 0 0 1 1.886 0c.52.52.52 1.365 0 1.885l-1.334 1.333c-.21.21-.474.331-.748.372l-.958.958a2.393 2.393 0 0 0 2.46-.576l1.334-1.333a2.402 2.402 0 0 0 0-3.394 2.393 2.393 0 0 0-1.697-.702Zm-1.61 3.46a.533.533 0 0 0-.367.162l-3.2 3.2a.533.533 0 1 0 .754.754l3.2-3.2a.534.534 0 0 0-.387-.915ZM6.586 7.973a2.388 2.388 0 0 0-1.816.697l-1.334 1.333a2.403 2.403 0 0 0 0 3.394 2.393 2.393 0 0 0 1.697.702c.614 0 1.229-.234 1.697-.702l1.333-1.334a2.4 2.4 0 0 0 .576-2.46l-.959.958a1.32 1.32 0 0 1-.37.749l-1.334 1.333a1.334 1.334 0 0 1-1.886-1.885l1.334-1.334c.21-.21.474-.331.748-.372l.958-.957c-.21-.07-.426-.11-.644-.122Z\" fill=\"#004B88\"\/>\n\t\t\t<\/svg>\n\n\t\t\t<span>Copy Link<\/span>\n\t\t<\/button>\n\t\t\t<\/div>\n\t<\/div>\n\t\t\t\t<div class=\"wp-block-kff-shared-content-main__content__inner\">\n\t\t\n\n<div class=\"wp-block-tenup-editorial-updates\">\n\t<div class=\"editorial-updates__top\">\n\t\t<h2 class=\"editorial-updates__title\"><\/h2>\n\t\t<p class=\"editorial-updates__description\"><strong>Editorial Note:<\/strong><em> This resource was originally published on February 24, 2025, and will be updated as needed to reflect additional developments.<\/em><\/p>\n\t<\/div>\n\n\t<\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Starting on the first day of his second term, President Trump began to issue numerous executive actions, several of which directly address or affect health programs, efforts, or policies to meet the health needs of LGBTQ+ people. This guide provides an overview of these actions, in the order in which they were issued. The \u201cdate issued\u201d is date the action was first taken; subsequent actions, such as litigation efforts, are listed under \u201cWhat Happens\/Implications.\u201d It is not inclusive of administrative actions that impact LGBTQ+ people that are not directly related to health and health care access, such as efforts related to participation in sport even though those actions might have an impact on well-being. In addition, within the actions examined, only provisions directly related to health and health access are described in table.<\/p>\n\n\n<div class=\"advgb-table-wrapper\">\n<table class=\"wp-block-advgb-table advgb-table-frontend table-p-font\"><tbody><tr><td style=\"background-color:#e5e5e5\" colspan=\"4\"><a href=\"https:\/\/www.whitehouse.gov\/presidential-actions\/2025\/01\/initial-rescissions-of-harmful-executive-orders-and-actions\/\"><strong>Initial Rescissions of Harmful Executive Orders and Actions<\/strong><\/a>, January 20, 2025<\/td><\/tr><tr><td style=\"vertical-align:top\"><strong>Purpose:<\/strong> Initial rescissions of Executive Orders and Actions issued by President Biden.<br><br>Among these orders are several that addressed LGBTQ+ equity including \u201cPreventing and Combating Discrimination on the Basis of Gender Identity or Sexual Orientation\u201d (Executive Order 13988) and \u201cAdvancing Equality for Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex Individuals\u201d (Executive Order 14075). The order establishing the White House Gender Policy Council (Executive Order 14020) and several Orders related to diversity, equity, and inclusion were also rescinded, as were orders related to nondiscrimination and equity in schools.<\/td><td style=\"vertical-align:top;border-right-color:#fff;border-style:none\" data-border-color=\"#fff\"><strong>Implications:<\/strong> This order could lead to less oversight, reduced health programing, and fewer policies protecting LGBTQ+ people, which could negatively impact access to care and well-being. Of particular note:<br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Rescinds orders that had called for LGBTQ+ people\u2019s health equity, the national public health needs of LGBTQ+ people, LGBTQ+ data collection, and nondiscrimination protections, including in health care.<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Rescinds orders that had called for nondiscrimination protections for LGBTQ+ young people in school, which could contribute to stigma and worsened mental health.<\/span><\/td><td style=\"vertical-align:top\"><\/td><\/tr><tr><td style=\"vertical-align:top;background-color:#e5e5e5\" colspan=\"4\"><a href=\"https:\/\/www.whitehouse.gov\/presidential-actions\/2025\/01\/defending-women-from-gender-ideology-extremism-and-restoring-biological-truth-to-the-federal-government\/\"><strong>Defending Women From Gender Ideology Extremism and Restoring Biological Truth to The Federal Government<\/strong><\/a>, January 20, 2025<\/td><\/tr><tr><td style=\"vertical-align:top\"><strong>Purpose:&nbsp;<\/strong>To define sex as an immutable binary biological classification and remove recognition of the concept of gender identity, including in sex protections and&nbsp;in agency operations.&nbsp;<br>&nbsp;<br>The order states that \u201cIt is the policy of the United States to recognize two sexes, male and female\u201d and directs the Executive Branch to \u201cenforce all sex-protective laws to promote this reality\u201d. Elements of the order that may affect LGBTQ people\u2019s health are as follows:<br><br>\u2022 Defines sex as \u201can individual\u2019s immutable biological classification as either male or female.\u201d&nbsp;States that \u201c\u2019sex\u2019 is not a synonym for and does not include the concept of \u2018gender identity\u2019\u201d and that gender identity \u201cdoes not provide a meaningful basis for identification and cannot be recognized as a replacement for sex.\u201d<br><br>\u2022 Defines male and female based on reproductive cell production.Introduces the term \u201cgender ideology\u201d which is defined to include &nbsp;\u201cthe idea that there is a vast spectrum of genders that are disconnected from one\u2019s sex\u201d and \u201cmaintains that it is possible for a person to be born in the wrong sexed body.\u201d<br><br>\u2022 Directs the Secretary of Health and Human Services (HHS) to provide the U.S. government, external partners, and the public guidance expanding on the sex-based definitions set forth in the order within 30 days.<br><br>\u2022 Directs each agency and all federal employees to \u201cenforce laws governing sex-based rights, protections, opportunities, and accommodations to protect men and women as biologically distinct sexes,\u201d including \u201cwhen interpreting or applying statutes, regulations, or guidance and in all other official agency business, documents, and communications.\u201d<br><br>\u2022 Directs each agency and all Federal employees, \u201cwhen administering or enforcing sex-based distinctions,\u201d to \u201cuse the term \u2018sex\u2019 and not \u2018gender\u2019 in all applicable Federal policies and documents.\u201d<br><br>\u2022 Directs agencies to \u201cremove all statements, policies, regulations, forms, communications, or other internal and external messages that promote or otherwise inclcate gender ideology, and shall cease issuing such statements, policies, regulations, forms, communications or other messages.\u201d<br><br>\u2022 Directs agency forms to exclude gender identity and directs agencies to \u201ctake all necessary steps, as permitted by law, to end the Federal funding of gender ideology.\u201d<br><br>\u2022 Requires that federal funds \u201cnot be used to promote gender ideology\u201d and directs agencies to ensure \u201cgrant funds do not promote gender ideology.\u201d<br><br>\u2022 Directs the Attorney General to ensure the Bureau of Prisons revises policies to prohibit federal funds from being expended \u201cfor any medical procedure, treatment, or drug for the purpose of conforming an inmate\u2019s appearance to that of the opposite sex.\u201d<br><br>\u2022 Rescinds multiple executive orders issued by President Biden, including: \u201cPreventing and Combating Discrimination on the Basis of Gender Identity or Sexual Orientation\u201d (13988), \u201cEstablishment of the White House Gender Policy Council\u201d (14020) (which is also dissolved), and \u201cAdvancing Equality for Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex Individuals\u201d (14075).<br><br>\u2022 Also directs agencies to rescind certain guidance documents, including, \u201cThe White House Toolkit on Transgender Equality\u201d; \u201cThe Attorney General\u2019s Memorandum of March 26, 2021 entitled \u201cApplication of <em>Bostock v. Clayton County<\/em>&nbsp;to Title IX of the Education Amendments of 1972,\u201d and range of orders related to LGBTQ+ students in schools.<br><br><br><br><\/td><td style=\"vertical-align:top;border-right-color:#fff;border-style:none\" data-border-color=\"#fff\"><strong>Implications:<\/strong> This order is broad, directed to all federal agencies and programs. Because federal health programs reach LGBTQ+ people, and some are specifically designed to be inclusive of the LGBTQ+ community, or account for gender identities in addition to biological sex, this Order could widely affect program funding, guidance, and access. It has several possible implications:<br><br>The terms used in the Order include several biological and social inaccuracies which could perpetuate misinformation about LGBTQ+ people and transgender people\u2019s health needs. It also takes steps towards ban gender care in certain area, most explicitly in prisons.<br><br>Requiring that federal funds are not used to \u201cpromote gender ideology\u201d has caused significant confusion. Since this order was issued, there have been multiple reports of HIV programs and community health centers that have lost funding as a result of supporting programs inclusive of transgender people. In addition, there have <a href=\"https:\/\/www.kff.org\/policy-watch\/president-trumps-executive-order-on-gender-affirming-care-responses-by-providers-states-and-litigation\/\">been reports<\/a> that some health care facilities paused providing youth with gender affirming care, fearing that federal funding would be withheld according to this and another Order relating to youth access to gender affirming care (see separate entry). (See court decisions below.) Withholding care could lead to negative health outcomes for those that require it.<br><br>Data collection and data presentation\/distribution have been impacted. At first some data was removed from federal websites, though due to court order this appears to have been restored. If public health messaging and services related to the health needs of transgender people, or other specific populations, are unavailable, this may result in adverse health outcomes such increased disease prevalence, greater difficulty with care engagement, and poor mental health outcomes. There have been <a href=\"https:\/\/www.npr.org\/2025\/02\/21\/nx-s1-5305265\/census-lgbtq-sogi-data-robert-santos\">reports<\/a> that gender identity questions will be removed from federal surveys which makes tracking the experiences and well-being of LGBTQ+ people more difficult.<br><br>The order directs the HHS Secretary to take action to end gender affirming care through Section 1557 of the Affordable Care Act (ACA), the law\u2019s major nondiscrimination provision, which includes protections on the basis of sex. While the Biden administration interpreted sex protections to include sexual orientation and gender identity, it is expected that the Trump administration will seek to remove these protections, as was the approach during his first term. Despite the Executive Orders and any future guidance, courts could continue to rule that such protections exist in statute.<br><br>On March 17<sup>th<\/sup> the <a href=\"https:\/\/news.va.gov\/press-room\/va-to-phase-out-treatment-for-gender-dysphoria\/\">VA announced<\/a> that it would phase out providing gender affirming care to comply with this Executive Order. Exceptions include Veterans already receiving hormone therapy from the VA or Veterans \u201creceiving such care from the military as part of and upon their separation from military service\u201d who are eligible for VA health care. The VA will not provide other gender affirming medical services.<br><br>The statement writes that historically the VA had provided a range of gender affirming services and \u201cletters of support encouraging non-VA providers to perform sex-change surgeries on Veterans.\u201d These services had been authorized under the now rescinded Veterans Health Administration Directive 1341(4).<br><br>There have been multiple legal challenges to this Order with some judicial actions that have paused aspects of implementation:<br><br>\u2022 On February 4, 2025 a lawsuit was filed in federal court challenging the Order on the grounds that it usurps Congressional&nbsp; power, violates Sec. 1557 of the ACA, and is unconstitutional and on February 11 a <a href=\"https:\/\/storage.courtlistener.com\/recap\/gov.uscourts.dcd.277069\/gov.uscourts.dcd.277069.11.0_1.pdf\">temporary restraining order<\/a>&nbsp; and&nbsp;<a href=\"https:\/\/storage.courtlistener.com\/recap\/gov.uscourts.dcd.277069\/gov.uscourts.dcd.277069.12.0_1.pdf\">memorandum opinion<\/a> was issued requiring restoration of webpages, datasets, and any other&nbsp; resources needed to provide medical care, identified by the Plaintiffs.<br><br>\u2022 On February 4, 2025, a separate federal <a href=\"https:\/\/lambdalegal.org\/wp-content\/uploads\/2025\/02\/PFLAG-v.-Trump-Complaint-DOCKETED.pdf\">lawsuit was filed<\/a><span> challenging this Order and the Executive Order on \u201cProtecting Children from Chemical and Surgical Mutilation\u201d (see separate entry), asserting they are openly discriminatory, unlawful, and unconstitutional. On February 13, a federal judge issued a <\/span><a href=\"https:\/\/storage.courtlistener.com\/recap\/gov.uscourts.mdd.575616\/gov.uscourts.mdd.575616.61.0_1.pdf\">temporary restraining order<\/a><span> preventing the federal government from withholding or conditioning funding on the basis of providing this care.<\/span><br><br>\u2022 An additional <a href=\"https:\/\/lambdalegal.org\/wp-content\/uploads\/2025\/02\/2025.02.19-ECF-1-Complaint.pdf\">suit was filed on<\/a><span> February 19, 2025 by the National Urban League, National Fair Housing Alliance, and AIDS Foundation of Chicago challenging three Executive Orders: \u201cEnding Radical and Wasteful DEI Programs and Preferencing\u201d, \u201cDefending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government\u201d and the \u201cEnding Illegal Discrimination and Restoring Merit-Based Opportunity\u201d as usurping the power of Congress, violating the Constitution and the Administrative Procedures Act, and, seeking declaratory and injunctive relief. In their complaint, plaintiffs highlight the potential harm this Order could bring to people with HIV and LGBTQ+ communities and the programs that serve them.<\/span><br><br>\u2022 On February 20, a separate case was <a href=\"https:\/\/lambdalegal.org\/wp-content\/uploads\/2025\/02\/1.pdf\">filed<\/a><span> in federal court by multiple LGBTQ+ health care and service organizations, challenging the \u201cEnding Radical and Wasteful DEI Programs and Preferencing\u201d, \u201cDefending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government\u201d and the \u201cEnding Illegal Discrimination and Restoring Merit-Based Opportunity\u201d Orders claiming they usurp the power of Congress and violate the Constitution. In their complaint, plaintiffs highlight the potential harm this Order could bring to people with HIV and LGBTQ communities and the programs that serve them. On June 9<sup>th<\/sup>, 2026, the court <a href=\"https:\/\/lambdalegal.org\/wp-content\/uploads\/2025\/06\/2025-06-09-SFAF-v.-Trump-Order-granting-PI-in-part.pdf\">issued<\/a> a preliminary injunction, blocking in part key provisions in this EO and in the DEI EO including those that instruct agencies to remove and cease to issue&nbsp; materials and \u201ccommunications\u2026that promote or otherwise inculcate gender ideology\u201d and instructing agencies to \u201cend the Federal funding of gender ideology\u201d; prohibit federal funds from being \u201cused to promote gender ideology,\u201d; and direct agencies and departments to terminate DEI offices and positions, materials, initiatives, performance requirements, and grants or contracts.<\/span><br><br>\u2022 On March 12, 2025 two physician and academic plaintiffs <a href=\"https:\/\/www.aclu.org\/cases\/schiff-v-office-of-personnel-management?document=Complaint#legal-documents\">filed a lawsuit<\/a> challenging the Order and related OPM memo when their articles were removed from HHS\u2019 Agency for Healthcare Research and Quality (AHRQ)\u2019s Patient Safety Network (PSNet), a federal online patient-safety resource. The reason for the removal articles was for their inclusion of passing references to transgender patients. On May 23, a MA district <a href=\"https:\/\/storage.courtlistener.com\/recap\/gov.uscourts.mad.281890\/gov.uscourts.mad.281890.43.0.pdf\">court found<\/a> the plaintiffs would likely succeed on their constitutional 1<sup>st<\/sup> amendment claims and granted a preliminary injunction requiring HHS to republish the censored content.<\/td><td style=\"vertical-align:top\"><\/td><\/tr><tr><td style=\"vertical-align:top;background-color:#e5e5e5\" colspan=\"4\"><a href=\"https:\/\/www.whitehouse.gov\/presidential-actions\/2025\/01\/ending-radical-and-wasteful-government-dei-programs-and-preferencing\/\"><strong>Ending Radical and Wasteful Government DEI Programs and Preferencing<\/strong><\/a>, January 20, 2025<\/td><\/tr><tr><td style=\"vertical-align:top\"><strong>Purpose: <\/strong>To limit&nbsp;diversity, equity, inclusion, and accessibility&nbsp;(DEIA)&nbsp;activities&nbsp;in&nbsp;government and by government contractors and grantees.&nbsp;&nbsp;<br>&nbsp;<br>Directs&nbsp;each agency, department, or commission head to take the following actions (among others):&nbsp;&nbsp;<br>\u2022 terminate, to the maximum extent allowed by law, all DEI, DEIA, and \u201cenvironmental justice\u201d offices and positions\u2026; all \u201cequity action plans,\u201d \u201cequity\u201d actions, initiatives, or programs, \u201cequity-related\u201d grants or contracts\u2026&nbsp;<br>\u2022 provide the Director of the OMB with a list of all \u201cfederal grantees who received Federal funding to provide or advance DEI, DEIA, or \u201cenvironmental justice\u201d programs, services, or activities since January 20, 2021,\u201d among other actions.&nbsp;&nbsp;<br><\/td><td style=\"vertical-align:top\"><strong>Implications:<\/strong> As with the other DEIA related Order (see separate entry), these efforts could make reaching populations with unique health needs in culturally competent ways more challenging, including in programs related to LGBTQ+ health and HIV. It could also jeopardized programs and funding for agencies reaching these communities.<br><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">There have been multiple legal challenges to this Order: <\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">On February 3, a lawsuit was filed by four diverse plaintiffs <\/span><a style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\" href=\"https:\/\/storage.courtlistener.com\/recap\/gov.uscourts.mdd.575287\/gov.uscourts.mdd.575287.1.0.pdf\">challenging<\/a><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\"> the constitutionality of this Order and the Order, \u201cEnding Illegal Discrimination and Restoring Merit-Based Opportunity\u201d.<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">An additional <\/span><a style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\" href=\"https:\/\/lambdalegal.org\/wp-content\/uploads\/2025\/02\/2025.02.19-ECF-1-Complaint.pdf\">suit was filed<\/a><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\"> in federal court on February 19, 2025 by the National Urban League, National Fair Housing Alliance, and AIDS Foundation of Chicago challenging this order as well as the \u201cDefending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government\u201d and the \u201cEnding Illegal Discrimination and Restoring Merit-Based Opportunity\u201d \u201d as usurping the power of Congress, violating the Constitution and the Administrative Procedures Act, and, seeking declaratory and injunctive relief. In their complaint, plaintiffs highlight the potential harm this Order could bring to people with HIV and LGBTQ communities and the programs that serve them.<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">On February 20, a separate case was <\/span><a style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\" href=\"https:\/\/lambdalegal.org\/wp-content\/uploads\/2025\/02\/1.pdf\">filed<\/a><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\"> in federal court by multiple LGBTQ+ health care and service organizations, challenging the \u201cEnding Radical and Wasteful DEI Programs and Preferencing\u201d, \u201cDefending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government\u201d and the \u201cEnding Illegal Discrimination and Restoring Merit-Based Opportunity\u201d orders claiming they usurp the power of Congress and violate the Constitution.&nbsp; In their complaint, plaintiffs highlight the potential harm this Order could bring to people with HIV and LGBTQ communities and the programs that serve them. On June 9<sup>th<\/sup>, 2026, the court <a href=\"https:\/\/lambdalegal.org\/wp-content\/uploads\/2025\/06\/2025-06-09-SFAF-v.-Trump-Order-granting-PI-in-part.pdf\">issued<\/a> a preliminary injunction, blocking in part key provisions in this EO and in the &#8220;gender ideology&#8221; EO including those that instruct agencies to remove and cease to issue&nbsp; materials and \u201ccommunications\u2026that promote or otherwise inculcate gender ideology\u201d and instructing agencies to \u201cend the Federal funding of gender ideology\u201d; prohibit federal funds from being \u201cused to promote gender ideology,\u201d; and direct agencies and departments to terminate DEI offices and positions, materials, initiatives, performance requirements, and grants or contracts.<\/span><\/td><td style=\"vertical-align:top\"><\/td><\/tr><tr><td style=\"vertical-align:top;background-color:#e5e5e5\" colspan=\"4\"><strong>Ending Illegal Discrimination and Restoring Merit-Based Opportunity, <\/strong>January 21, 2025<\/td><\/tr><tr><td style=\"vertical-align:top\"><strong>Purpose:<\/strong> Order seeks to end federal \u201cpreferencing\u201d through DEIA efforts within government and through contracting to the extent that they do not comply with the Administration\u2019s view of civil rights law. <br><br>The order is broad and non-specific but includes the following directives:<br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Orders all executive departments and agencies \u201cto terminate all discriminatory and illegal preferences, mandates, policies, programs, activities, guidance, regulations, enforcement actions, consent orders, and requirements.&nbsp; I further order all agencies to enforce our longstanding civil-rights laws and to combat illegal private-sector DEI preferences, mandates, policies, programs, and activities.\u201d<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Orders agency heads to include in every contract or grant award \u201ca term requiring the contractual counterparty or grant recipient to agree that its compliance in all respects with all applicable Federal anti-discrimination laws is material to the government\u2019s payment decisions for purposes of section 3729(b)(4) of title 31, United States Code; and\u2026A term requiring such counterparty or recipient to certify that it does not operate any programs promoting DEI that violate any applicable Federal anti-discrimination laws.\u201d<\/span><\/td><td style=\"vertical-align:top\"><strong>Implications:<\/strong> As with the other DEIA related Order (see separate entry), these efforts could make reaching populations with unique health needs in culturally competent ways more challenging, including in programs related to LGBTQ+ health and HIV. It could also jeopardized programs and funding for agencies reaching these communities.<br><br>There have been multiple legal challenges to this Order:<br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">On February 3, a lawsuit was filed by four diverse plaintiffs <\/span><a style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\" href=\"https:\/\/storage.courtlistener.com\/recap\/gov.uscourts.mdd.575287\/gov.uscourts.mdd.575287.1.0.pdf\">challenging<\/a><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\"> the constitutionality of this and the \u201cEnding Radical and Wasteful Government DEI Programs and Preferencing\u201d Order.<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">An additional <\/span><a style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\" href=\"https:\/\/lambdalegal.org\/wp-content\/uploads\/2025\/02\/2025.02.19-ECF-1-Complaint.pdf\">suit was filed<\/a><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\"> in federal court on February 19, 2025 by the National Urban League, National Fair Housing Alliance, and AIDS Foundation of Chicago challenging this order as well as the \u201cDefending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government\u201d and the \u201cEnding Radical and Wasteful Government DEI Programs and Preferencing\u201d as usurping the power of Congress, violating the Constitution and the Administrative Procedures Act, and, seeking declaratory and injunctive relief. In their complaint, plaintiffs highlight the potential harm this Order could bring to people with HIV and LGBTQ communities and the programs that serve them.<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">On February 20, a separate case was <\/span><a style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\" href=\"https:\/\/lambdalegal.org\/wp-content\/uploads\/2025\/02\/1.pdf\">filed<\/a><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\"> in federal court by multiple LGBTQ+ health care and service organizations, challenging the \u201cEnding Radical and Wasteful DEI Programs and Preferencing\u201d, \u201cDefending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government\u201d and the \u201cEnding Illegal Discrimination and Restoring Merit-Based Opportunity\u201d orders claiming they usurp the power of Congress and violate the Constitution.&nbsp; In their complaint, plaintiffs highlight the potential harm this Order could bring to people with HIV and LGBTQ communities and the programs that serve them.<\/span><\/td><td style=\"vertical-align:top\"><\/td><\/tr><tr><td style=\"vertical-align:top;background-color:#e5e5e5\" colspan=\"4\"><a href=\"https:\/\/Www.Whitehouse.Gov\/Presidential-Actions\/2025\/01\/Protecting-Children-From-Chemical-And-Surgical-Mutilation\/\"><strong>Protecting Children From Chemical and Surgical Mutilation<\/strong><\/a>, January 28, 2025<\/td><\/tr><tr><td style=\"vertical-align:top\"><strong>Purpose:<\/strong> Order directs agencies and programs to work towards significantly limiting access to gender affirming care for young people (defined as those under age 19) nationwide.<br><br>\u2022<span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\"> Directs agencies to rescind and amend policies that rely on guidance from the World Professional Association for Transgender Health (WPATH).<\/span><br><br>\u2022<span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\"> <\/span><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Directs the HHS Secretary to conduct and publish a review of existing literature and best practices related to gender affirming care and gender dysphoria and to \u201cincrease the quality of data to guide practices\u201c in this area.<\/span><br><br>\u2022<span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\"> <\/span><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Directs executive department and agency heads \u201cthat provide research or education grants to medical institutions, including medical schools and hospitals\u201d, \u201cin coordination with the Director of the Office of Management and Budget\u201d to \u201cimmediately take appropriate steps to ensure that institutions receiving Federal research or education grants end the chemical and surgical mutilation of children\u201d (which is how the Order defines gender affirming care).<\/span><br><br>\u2022<span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\"> <\/span><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Directs the HHS Secretary to take action to end gender affirming care for children \u201cincluding [through] regulatory and sub-regulatory actions, which may involve the following laws, programs, issues, or documents:<\/span><br><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">\u2013 Medicare or Medicaid conditions of participation or conditions for coverage<\/span><br><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">\u2013 clinical-abuse or inappropriate-use assessments relevant to State Medicaid programs<\/span><br><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">\u2013 mandatory drug use reviews<\/span><br><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">\u2013 section 1557 of the Patient Protection and Affordable Care Actquality, safety, and oversight memoranda<\/span><br><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">\u2013 essential health benefits requirements; and<\/span><br><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">\u2013 the Eleventh Revision of the International Classification of Diseases and other federally funded manuals, including the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.\u201d<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Withdraws Biden Administration \u201cHHS Notice and Guidance on Gender Affirming Care, Civil Rights and Patient Privacy\u201d and directs the Secretary of HHS \u201cin consultation with the Attorney General [to] issue new guidance protecting whistleblowers who take action related to ensuring compliance with this order.\u201d<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Directs the Secretary of the Department of Defense to \u201ccommence a rulemaking or sub-regulatory action\u201d restrict access to gender affirming care for children in the TRICARE program.<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Directs the Director of the Office of Personnel Management to limit access to care in coverage for federal employees\u2019 families by requiring \u201cprovisions in the Federal Employee Health Benefits (FEHB) and Postal Service Health Benefits (PSHB) programs call letter for the 2026 Plan Year\u201d that would require eligible carriers to exclude \u201ccoverage for pediatric transgender surgeries or hormone treatments\u2026\u201d<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Directs the Attorney General to review Department of Justice laws on female genital mutilation and \u201cprioritize enforcement of protections\u201d and \u201cto convene States\u2019 Attorneys General and other law enforcement officers to coordinate the enforcement of laws against female genital mutilation.\u201d<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Directs the Attorney General to \u201cprioritize investigations and take appropriate action to end deception of consumers, fraud, and violations of the Food, Drug, and Cosmetic Act by any entity that may be misleading the public about long-term side effects of chemical and surgical mutilation.\u201d<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Directs the Attorney General \u201cin consultation with the Congress\u201d \u201cto draft, propose, and promote legislation to enact a private right of action for children and the parents\u201d who have received gender affirming care \u201cwhich should include a lengthy statute of limitations.<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Directs the Attorney General to \u201cprioritize investigations and take appropriate action to end child-abusive practices by so-called sanctuary States that facilitate stripping custody from parents who support the healthy development of their own children, including by considering the application of the Parental Kidnapping Prevention Act and recognized constitutional rights.\u201d<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Directs agency heads included in this executive order to \u201csubmit a single, combined report to the Assistant to the President for Domestic Policy, detailing progress in implementing this order and a timeline for future action\u201d within 60 Days of its issuance.<\/span><\/td><td style=\"vertical-align:top\"><strong>Implications:<\/strong> If fully implemented, the Order would broadly and extensively limit access to gender affirming care for young people, across a range of payers and providers. Access to gender affirming care is associated with improved mental health outcomes for transgender people and limiting this care with negative ones, including poorer mental health outcomes. Additional impact includes:<br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">The executive order includes details about sex, gender identity, gender affirming care, and transgender people that conflict with science and evidence. These inaccuracies include suggesting that large shares of youth are seeking gender affirming medical care, that regret rates among those seeking care are high, and conflating \u201cfemale genital mutilation\u201d and gender-affirming care. This has the potential to promote hostility, stigma, and discrimination, and can lead to care denials.<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">It seeks to remove Federal reference to one of the standards of evidence-based care for transgender people in the US. Directing the HHS Secretary to develop new guidance without this standard, and in accordance with this and other orders, could limit agency ability to identify standards that adequately meet the needs of transgender people.<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">It also seeks to condition federal research and education grants on grantees not providing young people with gender affirming care.<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">There has already been some confusion with certain states and providers looking to preemptively comply with the order and another Order relating to \u201cgender ideology\u201d (see separate entry). <\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">The order lays groundwork for the Administration remove explicit protects for LGBTQ+ people in health care, including with respect to accessing gender affirming care. Specifically, the Order suggests a reinterpretation of sex protections in Section. 1557 of the Affordable Care Act void of explicit protections on the basis of sexual orientation and gender identity.<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">The order leans on laws and policies unrelated to gender affirming care in an effort to limit access to those services including by erroneously conflating gender affirming care and female genital mutilation, using the FDA regulatory process to limit access, and suggesting kidnapping protections be applied to parents in certain circumstance.<\/span><br><br>On February 19, 2025, additional <a href=\"https:\/\/womenshealth.gov\/article\/sex-based-definitions\">guidance<\/a> was released relating to this order, providing new and refined definition of terms \u201c which directs the Department of Health and Human Services (the Department) to promulgate clear guidance to the U.S. Government, external partners, and the public, expanding on the sex-based definitions set forth in the Executive Order.\u201d<br><br>On February 20, 2025, pursuant to this Order, HHS <a href=\"https:\/\/www.hhs.gov\/sites\/default\/files\/ocr-rescission-february-20-2025-notice-guidance.pdf\">issued a \u201cRecession<\/a> of \u2018HHS Notice and Guidance on Gender Affirming Care, Civil Rights, and Patient Privacy\u2019 issued by the Biden Administration\u201d which <a href=\"https:\/\/web.archive.org\/web\/20250116114241\/https:\/www.hhs.gov\/sites\/default\/files\/hhs-ocr-notice-and-guidance-gender-affirming-care.pdf\">had stated<\/a> the Administration \u201cstands with transgender and gender nonconforming youth\u201d and that medically necessary for gender affirming care for minors improves physical and mental health. It also reiterated that administration\u2019s view that Sec. 1557 of the ACA includes protections on the basis of sexual orientation and gender identity.<br><br>There have been multiple legal challenges to this Order with some judicial actions that have paused aspects of implementation:<br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">On February 4, 2025, a federal <\/span><a style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\" href=\"https:\/\/lambdalegal.org\/wp-content\/uploads\/2025\/02\/PFLAG-v.-Trump-Complaint-DOCKETED.pdf\">lawsuit was filed<\/a><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\"> challenging this Order and the Executive Order on \u201cDefending Women From Gender Ideology Extremism and Restoring Biological Truth to The Federal Government,\u201d asserting they are openly discriminatory, unlawful, and unconstitutional. On February 13, a federal judge issued a <\/span><a style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\" href=\"https:\/\/storage.courtlistener.com\/recap\/gov.uscourts.mdd.575616\/gov.uscourts.mdd.575616.61.0_1.pdf\">temporary restraining order<\/a><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\"> preventing the federal government from withholding or conditioning funding on the basis of providing this care. On March 4th, the <\/span><a style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\" href=\"https:\/\/storage.courtlistener.com\/recap\/gov.uscourts.mdd.575616\/gov.uscourts.mdd.575616.116.0.pdf\">court issued<\/a><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\"> a preliminary temporary injunction.<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">An additional federal lawsuit was <\/span><a style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\" href=\"https:\/\/storage.courtlistener.com\/recap\/gov.uscourts.wawd.344459\/gov.uscourts.wawd.344459.1.0_1.pdf\">filed<\/a><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\"> on February 7<\/span><sup style=\"font-family: inherit;font-weight: inherit;letter-spacing: 0px\">th<\/sup><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\"> challenging this executive order with a separate temporary restraining order being issued on <\/span><a style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\" href=\"https:\/\/storage.courtlistener.com\/recap\/gov.uscourts.wawd.344459\/gov.uscourts.wawd.344459.158.0.pdf\">the 14<sup>th<\/sup><\/a><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\"> preventing the conditioning of federal funds and also applying to a condition linking gender affirming care to female genital mutilation. The restraining order was <a href=\"https:\/\/www.courtlistener.com\/docket\/69614668\/pflag-inc-v-donald-j-trump\/\">extended<\/a> through March 5th on February 26th.&nbsp;<\/span><br><br>On June 1, the FBI <a href=\"https:\/\/x.com\/FBI\/status\/1929587710894739567\">posted<\/a> on social media urging the public to &#8220;report tips of any hospitals, clinics, or practitioners performing these surgical procedures on children,&#8221; despite pediatric gender affirming care being permitted in about half of states and not prohibited by the federal government.<\/td><td style=\"vertical-align:top\"><\/td><\/tr><tr><td style=\"vertical-align:top;background-color:#e5e5e5\" colspan=\"4\"><a href=\"https:\/\/www.whitehouse.gov\/presidential-actions\/2025\/01\/ending-radical-indoctrination-in-k-12-schooling\/\"><strong>Ending Radical Indoctrination in K-12 Schooling<\/strong><\/a>, January 29, 2025<\/td><\/tr><tr><td style=\"vertical-align:top\"><strong>Purpose: <\/strong>Order seeks to end federal \u201cpreferencing\u201d through DEIA efforts within government and through contracting to the extent that they do not comply with the Administration\u2019s view of civil rights law. <br><br>The order is broad and non-specific but includes the following directives:<br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Orders all executive departments and agencies \u201cto terminate all discriminatory and illegal preferences, mandates, policies, programs, activities, guidance, regulations, enforcement actions, consent orders, and requirements.&nbsp; I further order all agencies to enforce our longstanding civil-rights laws and to combat illegal private-sector DEI preferences, mandates, policies, programs, and activities.\u201d<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Orders agency heads to include in every contract or grant award \u201ca term requiring the contractual counterparty or grant recipient to agree that its compliance in all respects with all applicable Federal anti-discrimination laws is material to the government\u2019s payment decisions for purposes of section 3729(b)(4) of title 31, United States Code; and\u2026A term requiring such counterparty or recipient to certify that it does not operate any programs promoting DEI that violate any applicable Federal anti-discrimination laws.\u201d<\/span><\/td><td style=\"vertical-align:top\"><strong>Implications:<\/strong> Should the federal government proceed with conditioning federal funding for schools on whether or not they support transgender students, it could exacerbate existing mental health disparities, contribute to stigma and discrimination, and reduce school connectedness. For example, the policies detailed in the Order could prevent schools from recognizing transgender students\u2019 identities (e.g. their names and pronouns), allow schools to withhold mental health services, to out students to (potentially unsupportive) families, and to restrict facility use and activity participation.<\/td><td style=\"vertical-align:top\"><\/td><\/tr><tr><td style=\"vertical-align:top;background-color:#e5e5e5\" colspan=\"4\"><a href=\"https:\/\/www.whitehouse.gov\/presidential-actions\/2025\/02\/memorandum-for-the-heads-of-executive-departments-and-agencies\/\"><strong>Memorandum For The Heads Of Executive Departments And Agencies<\/strong><\/a>, February 6, 2025<\/td><\/tr><tr><td style=\"vertical-align:top\"><strong>Purpose:<\/strong> The memorandum seeks to \u201cstop funding Nongovernmental Organizations that undermine the national interest and administration priorities.\u201d <br><br>The memorandum states:<br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">It is Administration policy \u201cto stop funding [Nongovernmental Organizations] NGOs that undermine the national interest.\u201d<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Direct heads of executive departments and agencies to review all funding that agencies provide to NGOs and \u201cto align future funding decisions with the interests of the United States and with the goals and priorities of my Administration, as expressed in executive actions; as otherwise determined in the judgment of the heads of agencies; and on the basis of applicable authorizing statutes, regulations, and terms.\u201d<\/span><\/td><td style=\"vertical-align:top\"><strong>Implications:<\/strong> This memo aligns with other administrative efforts to stop current and future funding from being provided to NGOs that do not align with administrative priorities and could impact funding to health organizations or programs aimed at serving transgender people or research funding inclusive of trans and gender diverse people. It could also potentially impact care for LGBTQ+ people more broadly if services aimed directly at this population are considered DEIA efforts.<\/td><td style=\"vertical-align:top\"><\/td><\/tr><tr><td style=\"vertical-align:top;background-color:#e5e5e5\" colspan=\"4\"><a href=\"https:\/\/www.supremecourt.gov\/DocketPDF\/23\/23-477\/342223\/20250207133625781_Letter%2023-477.pdf\"><strong>DOJ Letter to the Supreme Court<\/strong><\/a><strong>: United States v. Jonathan Skrmetti, Attorney, <\/strong>February 7, 2025<\/td><\/tr><tr><td style=\"vertical-align:top\"><strong>Purpose:<\/strong> \u201cTo notify the Court that the government\u2019s previously stated views\u201d on a case challenging a state\u2019s ban on gender affirming care \u201cno longer represents the United States\u2019 position.\u201d<br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Notifies the Court that \u201cfollowing the change in Administration, the Department of Justice has reconsidered the United States\u2019 position in\u201d the case brought by the Biden Administration challenging Tennessee\u2019s ban on gender affirming care for minors. The letter states, that their view is that the Tennessee law being challenged \u201cdoes not deny equal protection on account of sex or any other characteristic,\u201d which is the question before the Court.<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Despite this change in perspective, the Trump Administration encouraged the Court to resolve the questions presented without granting certiorari to the original plaintiffs.<\/span><\/td><td style=\"vertical-align:top\"><strong>Implications:<\/strong> There are 26 states with bans on gender affirming care for minors and litigation challenging these bans is ongoing. At the request of the Biden Administration, who brought the plaintiff\u2019s case from the lower courts, the Supreme Court agreed to examine whether the Tennessee ban violates Equal Protection constitutional protections under the 14<sup>th<\/sup> Amendment. The case was briefed and argued prior to the administration change. Upon taking office, the Trump Administration wrote this letter to the Court stating that the Biden Administration position no longer represented that of the U.S. government but nevertheless asked the court to decide the case. The court will likely issue a decision in the case and technically, the Trump Administration letter should not have bearing on the court\u2019s decision. The court is expected to issue a decision in the case this summer (2025).<\/td><td style=\"vertical-align:top\"><\/td><\/tr><tr><td style=\"vertical-align:top;background-color:#e5e5e5\" colspan=\"4\"><a href=\"https:\/\/www.cms.gov\/files\/document\/qssam-25-02-hospitals.pdf\"><strong>Quality<\/strong> <strong>and Safety Special Alert Memo on Provision of Gender Affirming Care to Children<\/strong><\/a>, March 5, 2025<\/td><\/tr><tr><td style=\"vertical-align:top\"><strong>Purpose:<\/strong> To alert providers to the administration\u2019s approach to children\u2019s access to gender affirming care and serve as notice \u201cthat CMS may begin taking steps in the future to align policy, including CMS-regulated provider requirements and agreements\u2026\u201d to limit such care. <br><br>The memorandum states:<br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">That \u201cCMS renews its commitment to promoting evidence-based standards through health quality and safety improvement activities, and reminds hospitals and other applicable facilities and providers of the obligation to prioritize the health and safety of their patients, especially children.\u201d It questions evidence around gender affirming care for young people and states \u201cCMS may begin taking steps in the future to adjust its policies to reflect this\u2026\u201d<\/span><\/td><td style=\"vertical-align:top\"><strong>Implications: <\/strong><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">The CMS memo aligns with policies put forward in the Executive Order, \u201cProtecting Children From Chemical and Surgical Mutilation,\u201d related to limiting young people\u2019s access to gender affirming care, provisions of which are subject to a nationwide preliminary injunction (described in above entry). However, this is not explicitly stated in the memo.<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">On March 6<\/span><sup style=\"font-family: inherit;font-weight: inherit;letter-spacing: 0px\">th<\/sup><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\"> the <\/span><a style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\" href=\"https:\/\/www.hrsa.gov\/sites\/default\/files\/hrsa\/grants\/march-2025-letter-hospital-admins-grantees.pdf\">Health Resources &amp; Services Administration<\/a><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\"> (HRSA) and Substance Abuse and Mental Health Services Administration (SAMHSA) released additional guidance stating that they would review policies, grants, and programs for consistency with the CMS memo (SAMHSA letter unavailable but described in <\/span><a style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\" href=\"https:\/\/assets.aclu.org\/live\/uploads\/2025\/03\/ECF-118-1.pdf\">this filing<\/a><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">). HRSA also specifically notes the agency will review its Children\u2019s Hospitals Graduate Medical Education (CHGME) Payment Program for consistency with the memo.<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">While the memo does not specifically refer to the Executive Order, on March 7<\/span><sup style=\"font-family: inherit;font-weight: inherit;letter-spacing: 0px\">th<\/sup><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">, plaintiffs in a case challenging the order <\/span><a style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\" href=\"https:\/\/assets.aclu.org\/live\/uploads\/2025\/03\/ECF-118-1.pdf\">sought enforcement<\/a><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\"> of the preliminary injunction claiming that the CMS memo and HRSA\/SAMHSA guidance violate its terms because by \u201cthreatening to withhold federal funding, the Executive Orders coerced hospitals into immediately shutting down gender affirming medical care for people under nineteen to avoid potential loss of funds.\u201d<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Depending on how future policy is implemented, CMS could seek to significantly limit access to gender affirming care for young people.<\/span><\/td><td style=\"vertical-align:top\"><\/td><\/tr><tr><td style=\"vertical-align:top;background-color:#e5e5e5\" colspan=\"4\"><a href=\"https:\/\/www.whitehouse.gov\/presidential-actions\/2025\/04\/national-child-abuse-prevention-month-2025\/\"><strong>National Child Abuse Prevention Month, 2025<\/strong><\/a> April 3, 2025<\/td><\/tr><tr><td style=\"vertical-align:top\"><strong>Purpose: <\/strong>The memorandum seeks to \u201cstop funding Nongovernmental Organizations that undermine the national interest and administration priorities.\u201d <br><br>The memorandum states:<br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">It is Administration policy \u201cto stop funding [Nongovernmental Organizations] NGOs that undermine the national interest.\u201d<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Direct heads of executive departments and agencies to review all funding that agencies provide to NGOs and \u201cto align future funding decisions with the interests of the United States and with the goals and priorities of my Administration, as expressed in executive actions; as otherwise determined in the judgment of the heads of agencies; and on the basis of applicable authorizing statutes, regulations, and terms.\u201d<\/span><\/td><td style=\"vertical-align:top\"><strong>Implications:<\/strong><br><br><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">The proclamation includes details about gender affirming care and transgender people that conflict with science and evidence, including that children are being \u201cindoctrinated\u201d \u201cwith the devastating lie that they are trapped in the wrong body,\u201d referring to gender affirming surgery (which is very rare among young people) as \u201csexual mutilation surgery,\u201d&nbsp; and suggesting that such care inhibits \u201chappiness, health, and freedom,\u201d for young people and creates \u201cheartbreak\u201d for parents and families.<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">By erroneously conflating gender affirming care and abuse, potentially threatens those providing or facilitating access by stating, \u201cwe affirm that every perpetrator who inflicts violence on our children will be punished to the fullest extent of the law.\u201d<\/span><\/td><td style=\"vertical-align:top\"><\/td><\/tr><tr><td style=\"vertical-align:top;background-color:#e5e5e5\" colspan=\"4\"><a href=\"https:\/\/ryanwhite.hrsa.gov\/sites\/default\/files\/ryanwhite\/about-program\/letter-grantees-rwhap-4-2025.pdf\"><strong>Ryan White Letter to Awardees and Stakeholder<\/strong><\/a><strong>s Relating to Gender Affirming Care, <\/strong>April 7, 2025.<\/td><\/tr><tr><td style=\"vertical-align:top\"><strong>Purpose:<\/strong> Reverses a Biden Administration policy that had permitted the Ryan White HIV\/AIDS Program to cover certain gender affirming care services as a part of whole person care to transgender people with HIV.<br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Referring to a <\/span><a style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\" href=\"https:\/\/ryanwhite.hrsa.gov\/sites\/default\/files\/ryanwhite\/hiv-care\/gender-affirming-care-rwhap.pdf\">policy on gender affirming care<\/a><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\"> from the Biden administration, the letter states that \u201cunder the previous administration, certain interpretations of RWHAP\u2019s allowable uses\u2026co-opted the program\u2019s patient centered mission in favor of radical ideological agendas and policies.\u201d<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">The letter further states &#8220;that RWHAP funds shall be marshaled exclusively toward evidence-based interventions proven to combat HIV, sustain viral suppression, and improve the quality of life for those living with the disease\u201d and reaffirms the prohibition on funding services outside the scope of outpatient care, including \u201csurgeries and inpatient care, irrespective of setting or anesthesia\u201d<\/span><\/td><td style=\"vertical-align:top\"><strong>Implications: <\/strong><br><br>\u2022 <a style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\" href=\"https:\/\/ryanwhite.hrsa.gov\/sites\/default\/files\/ryanwhite\/hiv-care\/gender-affirming-care-rwhap.pdf\">Previously<\/a><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">, Ryan White funds were permitted to be used to support gender affirming care within core medical and support service categories, including through the provision of hormones via ADAP programs. Additionally, funds could be used to \u201cprovide behavioral and mental health services to clients experiencing gender dysphoria and social and emotional stress related to transgender discrimination, stigma, and rejection.\u201d The policy under the prior Administration prohibited surgery, as does the new one, so that does not represent a change.<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Prohibiting use of funds to support certain gender affirming care services may make care engagement more challenging for transgender Ryan White clients. In some cases, gender affirming care may have helped to connect clients with HIV services and thus improve HIV outcomes.<\/span><\/td><td style=\"vertical-align:top\"><\/td><\/tr><tr><td style=\"vertical-align:top;background-color:#e5e5e5\" colspan=\"4\"><a href=\"https:\/\/www.federalregister.gov\/documents\/2025\/04\/11\/2025-06127\/nondiscrimination-on-the-basis-of-disability-in-programs-or-activities-receiving-federal-financial\"><strong>Nondiscrimination on the Basis of Disability in Programs or Activities Receiving Federal Financial Assistance; Clarification<\/strong><\/a><strong>, April 11, 2025.<\/strong><\/td><\/tr><tr><td style=\"vertical-align:top\"><strong>Purpose<\/strong>: HHS issued this notice \u201cto clarify the non-enforceability of certain language that was included in the preamble to\u2014but not the regulatory text of\u201d the final rule on Section 504, \u201ctitled \u2018Nondiscrimination on the Basis of Disability in Programs or Activities Receiving Federal Financial Assistance.\u2019 The clarification states that language in the preamble concerning gender dysphoria, which is not in the regulatory text, does not have the force or effect of law and cannot be enforced.<\/td><td style=\"vertical-align:top\"><strong>Implications:<\/strong><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Section 504 prohibits recipients of federal funding, including publicly-subsidized health payers and health care providers who accept Medicare or Medicaid, from discriminating against people on the basis of disability. The <\/span><a style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\" href=\"https:\/\/www.federalregister.gov\/documents\/2024\/05\/09\/2024-09237\/nondiscrimination-on-the-basis-of-disability-in-programs-or-activities-receiving-federal-financial\">Biden Administration\u2019s final<\/a><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\"> rule on Sec. 504 included in the preamble that HHS would \u201capproach gender dysphoria as it would any other disorder or condition. If a disorder or condition affects one or more body systems, or is a mental or psychological disorder, it may be considered a physical or mental impairment.\u201d<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">This new interpretation could weaken certain protections for transgender and gender non-conforming people.<\/span><\/td><td style=\"vertical-align:top\"><\/td><\/tr><tr><td style=\"vertical-align:top;background-color:#e5e5e5\" colspan=\"4\"><a href=\"https:\/\/www.cms.gov\/files\/document\/letter-stm.pdf\"><strong>State Medicaid Director Letter \u201cRe: Puberty blockers, cross-sex hormones, and surgery related to gender dysphoria,\u201d<\/strong><\/a> &nbsp;April 11, 2025.<\/td><\/tr><tr><td style=\"vertical-align:top\"><strong>Purpose:<\/strong> \u201cThe purpose of this letter is to ensure that state Medicaid agencies are aware of growing evidence regarding certain procedures offered to children, and to remind states of their responsibility to ensure that Medicaid payments are consistent with quality of care and that covered services are provided in a manner consistent with the best interest of recipients.\u201d<br><br><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">States that \u201cmedical interventions for gender dysphoria in children have proliferated\u201d and that \u201cseveral developed countries have recently diverged from the U.S. in the way they treat gender dysphoria in children.\u201d<\/span><br><br>CM<span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">S reminds states of the following federal Medicaid requirements:<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Program \u201cresponsibility to ensure that payments are consistent with \u2018efficiency, economy, and quality of care.\u2019\u201d<\/span><br><br><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">\u2022 Requirement for states to \u201cprovide such safeguards as may be necessary to ensure covered care and services are provided in a manner consistent with the best interests of recipients.\u201d<\/span><br><br><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">\u2022 Prohibition on \u201cfederal funding for coverage of services whose purpose is to permanently render an individual incapable of reproducing. Federal financial participation (FFP) is strictly limited for procedures, treatments, or operations for the purpose of rendering an individual permanently incapable of reproducing and\u2026prohibited for such procedures performed on a person under age 21.\u201d<\/span><br><br><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">\u2022 Drug utilization review (DUR) program requirements \u201cto assure that prescribed drugs are appropriate, medically necessary, and are not likely to result in adverse results.\u201d<\/span><br>\u2013 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">CMS encourages \u201cstates to review their DUR programs to ensure alignment with current medical evidence and federal requirements, including the evidence outlined above.<\/span><br>\u2013 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Notes that \u201cadditional guidance on DUR approaches is forthcoming.\u201d<\/span><\/td><td style=\"vertical-align:top\"><strong>Implications<\/strong>:<br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Letter appears to encourage states to take steps to limit gender affirming care for youth within their state Medicaid programs and suggests that not doing so could put them out of compliance with federal law. It does not immediately change policy.<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Letter misrepresents certain information about gender affirming care including its frequency and the approach in international settings.<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Letter leverages <\/span><a style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\" href=\"https:\/\/www.law.cornell.edu\/cfr\/text\/42\/441.253\">a law<\/a><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\"> aimed at addressing discrimination\/unwanted sterilizations among people with disabilities to limit gender affirming care.<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">The letter could lead to changes in state policy-making or make providers and\/or employers less likely to cover services which could ultimately lead to more limited access to GAC.&nbsp;<\/span><br><br>\u2022 <a style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\" href=\"https:\/\/www.cms.gov\/newsroom\/press-releases\/statement-cms-administrator-dr-mehmet-oz-letter-state-medicaid-agencies\">CMS issued a press release<\/a><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\"> along with the letter. The letter stated &#8220;Medicaid dollars are not to be used for gender reassignment surgeries or hormone treatments in minors.&#8221;<\/span><\/td><td style=\"vertical-align:top\"><\/td><\/tr><tr><td style=\"vertical-align:top;background-color:#e5e5e5\" colspan=\"4\"><a href=\"https:\/\/www.lawdork.com\/p\/read-ag-bondis-memo-purporting-to\"><strong>Department of Justice Memorandum \u201cPreventing the Mutilation of American Children,\u201d<\/strong><\/a> April 22, 2025.<\/td><\/tr><tr><td style=\"vertical-align:top\"><strong>Purpose:<\/strong> An internal Department of Justice (DOJ) <a href=\"https:\/\/www.lawdork.com\/p\/read-ag-bondis-memo-purporting-to\">memorandum<\/a> seeks to implement, in part, an <a href=\"https:\/\/www.whitehouse.gov\/presidential-actions\/2025\/01\/protecting-children-from-chemical-and-surgical-mutilation\/\">executive order<\/a> aimed at limiting minor\u2019s access to gender affirming care (GAC) (see above).<br><br>The memo is an internal document that was leaked. It is not law but provides guidance relating to an earlier executive order aimed at limiting minor access to gender affirming care (see above). The memo reportedly:<br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">The internal document was leaked and is not law but provides guidance relating to an earlier executive order aimed at limiting minor access to gender affirming care.<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Puts providers \u201con notice\u201d that \u201cit is a felony to perform, attempt to perform, or conspire to perform female genital mutilation (&#8220;FGM&#8221;*) on\u201d minors and states that the FBI \u201calongside federal, state, and local partners, will pursue every legitimate lead on possible FGM cases.\u201d<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">States DOJ \u201cwill investigate and hold accountable medical providers and pharmaceutical companies that mislead the public about the long-term side effects of chemical and surgical mutilations.\u201d<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Directs \u201cinvestigations of any violations of the Food, Drug, and Cosmetic Act by manufacturers and distributors engaged in misbranding by making false claims about the\u2026use of puberty blockers, sex hormones, or any other drug\u201d in GAC.<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Directs \u201cinvestigations under the False Claims Act of false claims submitted to federal health care programs for any non-covered services related to radical gender experimentation.\u201d Gives example of prescribing puberty blockers to a minor for GAC but reporting the service as being for early onset puberty. States Department will work with whistleblowers \u201cwith knowledge of any such violations\u201d under The False Claims Act.<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Following prior direction \u201cthat Department employees shall not rely on\u201d\u2026 the World Professional Association for Transgender Health<\/span><strong style=\"font-family: inherit;font-size: inherit;letter-spacing: 0px\"> (<\/strong><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">WPATH)\u2026 \u201cguidelines, and that they should withdraw all court filings\u201d doing so, \u201cexpressly extend[s] that direction to all Department employees.\u201d Directs department to \u201cpurge all\u2026policies, memoranda, and publications and court filings based on WPATH guidelines.\u201d<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Launches \u201cthe Attorney General&#8217;s Coalition Against Child Mutilation\u201d to \u201cpartner with state attorneys general to identify leads, share intelligence, and build cases against\u2026\u201d providers \u201c\u2026violating federal or state laws banning female genital mutilation and other, related practices\u2026[and] support the state-level prosecution of medical professionals who violate state laws \u201cprohibiting gender affirming care.<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Instructs Office of Legislative Affairs to draft legislation \u201ccreating a private right of action for children and the parents of children\u201d who have had gender affirming care with \u201ca long statute of limitations and retroactive liability\u201d and work with Congress \u201cto bring this bill to President Trump.\u201d<\/span><ul>&nbsp;<\/ul><\/td><td style=\"vertical-align:top\"><strong>Implications:<\/strong><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">The memo directs action but is not law. It seeks to implement an executive order that is, in part, currently enjoined in court.<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">The memo includes inaccuracies relating to gender identity, gender affirming care, and transgender people that conflict with science and evidence. These inaccuracies include suggesting that being transgender is a harmful medical condition, that large shares of youth are seeking gender affirming medical care, that regret rates among those seeking care are high, and conflating \u201cfemale genital mutilation\u201d and gender-affirming care. This has the potential to promote hostility, stigma, and discrimination, and can lead to care denials.<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Seeks to discredit WPATH\u2019s widely relied on standard of care guidelines which providers look to deliver best practices gender affirming care and is regularly referenced by major <\/span><a style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\" href=\"https:\/\/www.supremecourt.gov\/DocketPDF\/18\/18-107\/107178\/20190703172653326_Amicus%20Brief.pdf\">medical associations<\/a><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\"> including the <\/span><a style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\" href=\"https:\/\/www.apa.org\/about\/policy\/resolution-gender-identity.pdf\">American Psychological Association<\/a><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">.<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">While nothing in the memo prohibits provision of gender affirming care, its emphasis on litigation and enforcement of existing law that do not necessarily implicate this care, could have a chilling effect on providers.<\/span><ul>&nbsp;<\/ul><\/td><td style=\"vertical-align:top\"><\/td><\/tr><tr><td style=\"vertical-align:top;background-color:#e5e5e5\" colspan=\"4\"><strong>HHS Report \u201c<\/strong><a href=\"https:\/\/opa.hhs.gov\/sites\/default\/files\/2025-05\/gender-dysphoria-report.pdf\"><strong>Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices<\/strong><\/a><strong>,\u201d<\/strong> May 1, 2025.<\/td><\/tr><tr><td style=\"vertical-align:top\"><strong>Purpose:<\/strong> To develop an evidence review around pediatric gender affirming medical care as commissioned by the executive order on <a href=\"https:\/\/www.whitehouse.gov\/Presidential-Actions\/2025\/01\/Protecting-Children-From-Chemical-And-Surgical-Mutilation\/\">Protecting Children From Chemical and Surgical Mutilation<\/a> (see above entry). <br><br>\u201cThis Review of evidence and best practices was commissioned pursuant to Executive Order 14187, signed on January 28, 2025. It is not a clinical practice guideline, and it does not issue legislative or policy recommendations. Rather, it seeks to provide the most accurate and current information available regarding the evidence base for the treatment of gender dysphoria in this population, the state of the relevant medical field in the United States, and the ethical considerations associated with the treatments offered. The Review is intended for policymakers, clinicians, therapists, medical organizations and, importantly, patients and their families.\u201d Among the report\u2019s findings:<br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Report concludes that the quality of evidence on the effects of gender affirming intervention is low but also that evidence on harms is \u201csparse.\u201d<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Cites \u201csignificant risks\u201d of medical transition, departing from most medical associations and widely used guidelines in the U.S.<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">In addition to a focus on medical intervention (e.g. surgery, puberty blockers, and hormones) report discusses role of psychotherapy in gender affirming care, supporting the use of psychotherapeutic approaches, including an approach termed \u201cexploratory therapy\u201d, which can include conversion therapy. Conversion therapy is a practice that seeks to change an individual&#8217;s sexual orientation or gender identity. These practices contrast with recommendations from major medical associations, which <\/span><a style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\" href=\"https:\/\/www.kff.org\/mental-health\/issue-brief\/u-s-department-of-health-and-human-services-report-on-pediatric-gender-dysphoria-and-gender-conversion-efforts\/\">criticize<\/a><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\"> conversion efforts for their lack evidence, ineffectiveness, and because they can cause harm.&nbsp;Additionally, many states <\/span><a style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\" href=\"https:\/\/www.lgbtmap.org\/equality-maps\/conversion_therapy\">ban<\/a><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\"> these practices for the same reasons.<\/span><\/td><td style=\"vertical-align:top\"><strong>Implications: <\/strong><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">Review could be used as support for other actions the administration seeks to take (some&nbsp;<\/span><a style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\" href=\"https:\/\/www.kff.org\/other\/fact-sheet\/overview-of-president-trumps-executive-actions-impacting-lgbtq-health\/\">described here<\/a><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">) aimed at limiting minor access to gender affirming care. Outside experts, including from the <\/span><a style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\" href=\"https:\/\/www.aap.org\/en\/news-room\/news-releases\/aap\/2025\/aap-statement-on-hhs-report-treatment-for-pediatric-gender-dysphoria\/\">American Academy of Pediatrics<\/a><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">, have raised concerns that the \u201creport misrepresents the current medical consensus and fails to reflect the realities of pediatric care.\u201d<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">With respect to therapeutic practices, it could shift how some practitioners approach gender affirming care or potentially provide support to those using conversion related approaches.<\/span><br><br>\u2022 <span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\">The report could also fuel <\/span><a style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\" href=\"https:\/\/www.kff.org\/the-monitor\/new-vaccine-requirements-anti-mrna-narratives-and-disputed-gender-affirming-care-report\">misinformation<\/a><span style=\"font-family: inherit;font-size: inherit;font-weight: inherit;letter-spacing: 0px\"> in other areas, particularly around regret rates (which the report states are high when they are actually very low) and the share of young people seeking a medical transition (which the report states is large, when the share is small).<\/span><br><br><span>On May 28, 2025, HHS sent a <\/span><a href=\"https:\/\/x.com\/HHSGov\/status\/1927791449476567043\">letter<\/a><span> to an unspecified group of providers, state medical boards, and health risk managers urging providers to update treatment protocol to align with the review\u2019s findings and avoid relying on the WPATH Standards of Care (which are seen by gender affirming care providers as valuable and trusted source of guidance.) The letter points to risk but not benefits of gender affirming medical care and highlights the report&#8217;s promotion of psychotherapy as an alternative to other medical care.<\/span><\/td><td style=\"vertical-align:top\"><\/td><\/tr><tr><td style=\"vertical-align:top;background-color:#e5e5e5\" colspan=\"4\"><a href=\"https:\/\/www.cms.gov\/files\/document\/hospital-oversight-letter-generic.pdf\"><strong>HHS Letter \u201cUrgent Review of Quality Standards and Gender Transition Procedures\u201d<\/strong><\/a> May 28, 2025<\/td><\/tr><tr><td style=\"vertical-align:top\"><strong>Purpose<\/strong>: The letter from the Center for Medicare and Medicaid Services (CMS) is directed at \u201cselect <a href=\"https:\/\/www.cms.gov\/newsroom\/press-releases\/cms-launches-oversight-initiative-hospitals-performing-experimental-sex-trait-modification\">hospitals<\/a>\u201d providing minors with gender affirming care services including puberty blockers, hormones, and surgeries. The aim of the letter is to collect information on the delivery of these services and their associated costs and revenue. CMS states they are collecting this data to \u201censure quality standards at institutions participating in the Medicare and Medicaid programs\u201d and because \u201cCMS has an obligation to be a good steward of taxpayer dollar.\u201d&nbsp;<br><br>In the letter CMS asks for information on the following within 30 days:<br>\u2022 consent protocols for children with gender dysphoria, including when parental consent is required<br>\u2022 changes to clinical practice guidelines and protocols in light of the <a href=\"https:\/\/www.kff.org\/mental-health\/issue-brief\/u-s-department-of-health-and-human-services-report-on-pediatric-gender-dysphoria-and-gender-conversion-efforts\/\">HHS Review<\/a> (see above entry)<br>\u2022 adverse events, particularly children who later look to detransition<br>billing codes utilized for gender affirming care<br>\u2022 facility and provider-level revenue and profit margins data related to these services<br><\/td><td style=\"vertical-align:top\"><strong>Implications: <\/strong>If facilities or providers believe HHS is excessively engaged in oversight of their practice of this area of medicine, it could have a chilling effect on willingness to provide these treatments. Depending on what the Administration does with data collected, this effort could represent a significant step in the administration\u2019s aim to limit GAC for minors.<br><br>The effort to collect this level of information is likely burdensome for providers, particularly within a 30-day period.<br><br>The letter appears to stoke misinformation in its suggestion that there is a lack of parental involvement or consent in the practice of gender affirming care and that regret is a serious problem in this field.<br><br>It also appears to question the validity of using federal dollars to provide this care and possibly that delivering these services to minors is a significant cost-burden to the federal government. Because just a small share of the population is transgender, and not all trans people seek medical intervention, costs are <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC9679590\/\">likely very low<\/a>.<\/td><td style=\"vertical-align:top\"><\/td><\/tr><tr><td style=\"vertical-align:top;background-color:#e5e5e5\" colspan=\"4\"><a href=\"https:\/\/www.medicaid.gov\/federal-policy-guidance\/downloads\/cib06052025.pdf\"><strong>CMS Informational Bulletin \u201cRescission of Guidance on Adding Sexual Orientation and Gender Identity Questions to State Medicaid and CHIP Applications for Health Coverage\u201d <\/strong><\/a>&nbsp;June 5, 2025<\/td><\/tr><tr><td style=\"vertical-align:top\"><strong>Purpose<\/strong>: To rescind a <a href=\"https:\/\/www.hhs.gov\/guidance\/sites\/default\/files\/hhs-guidance-documents\/AID\/cib11092023.pdf\">bulletin<\/a> from the Biden administration that provided state Medicaid programs with guidance on implementing optional sexual orientation and gender identity (SOGI) questions on their applications for coverage.<br><br>The Trump administration bulletin states that \u201cCMS no longer intends to collect this information from state Medicaid and Children\u2019s Health Insurance Program (CHIP) agencies as part of Transformed Medicaid Statistical Information System (T-MSIS) data submissions.\u201d<\/td><td style=\"vertical-align:top\"><strong>Implications: <\/strong>Collection of SOGI health data plays a role in documenting the health experiences and status of LGBTQ+ people. Data collection can reveal disparities and gaps in access, which can, in turn, inform policy making to address these challenges. Without this data, addressing these disparities is more challenging. SOGI Data collection expanded under the Biden administration and has retracted under the Trump administration.<\/td><td style=\"vertical-align:top\"><\/td><\/tr><tr><td style=\"vertical-align:top;background-color:#e5e5e5\" colspan=\"3\"><a href=\"https:\/\/www.federalregister.gov\/documents\/2025\/06\/25\/2025-11606\/patient-protection-and-affordable-care-act-marketplace-integrity-and-affordability\"><strong>Final Rule Changing ACA Coverage of Gender-Affirming Care<\/strong><\/a>, June 25, 2025.<\/td><td style=\"vertical-align:top;background-color:#e5e5e5\"><\/td><\/tr><tr><td style=\"vertical-align:top\"><strong>Purpose: To rescind a <a href=\"https:\/\/www.hhs.gov\/guidance\/sites\/default\/files\/hhs-guidance-documents\/AID\/cib11092023.pdf\">bulletin<\/a> from the Biden administration that provided state Medicaid programs with guidance on implementing optional sexual orientation and gender identity (SOGI) questions on their applications for coverage.<\/strong><br><br>The Trump administration bulletin states that \u201cCMS no longer intends to collect this information from state Medicaid and Children\u2019s Health Insurance Program (CHIP) agencies as part of Transformed Medicaid Statistical Information System (T-MSIS) data submissions.\u201d<\/td><td style=\"vertical-align:top\"><strong>Implications:<\/strong> The aim of the final rule aligns with policies expressed in Executive Orders on gender and limiting access to gender affirming care (discussed above), though the agency states the rule does not rely on these orders or their enjoined sections. The agency writes that the purpose of the rule is to ensure that health plans meet the ACA\u2019s \u201ctypicality requirement,\u201d that is that EHBs be \u201cequal to the scope of benefits provided under a typical employer plan.\u201d The preamble to the rule discusses debate among commenters about whether inclusion of these services is typical.<br><br>The rule does not mean that plans cannot cover gender affirming care services but excluding certain services from coverage as EHBs means that enrollees would not be assured the same cost-sharing and benefit design protections as for services included in the EHB package. Costs accrued for gender affirming care would not be required to count towards deductibles or out-of-pocket maximums and would not be protected from annual or lifetime limits, increasing out-of-pocket liability. Additionally, the portion of premiums attributable to specified gender affirming services would not be eligible for premium tax credits or cost-sharing reductions for low- and moderate-income enrollees.<br><br>While CMS does not believe the impact will be significant, some commenters expressed concern that the policy change, particularly its near implementation date for 2026 plan year, could create challenges for issuers, which have already been engaged in (and some completed) rate setting for 2026. They also stated that change would require plans that cover gender affirming care outside of the EHB to complete the necessary backend activities (e.g. changes to claims and utilization management programs and policies) to implement the change, activities that could be more burdensome for smaller issuers.<br><br>While HHS states that this rule does not violate various statues (e.g. ACA\u2019s nondiscrimination provisions at Sec. 1557 or typicality requirements, ADA\u2019s Section 505 protections, constitutional equal protections, etc.) and disagrees with those who commented on the proposed rule that HHS lacks legal authority to make these policy changes, the rule could ultimately face legal challenges on these or other grounds.<\/td><td style=\"vertical-align:top\"><\/td><\/tr><tr><td style=\"vertical-align:top\" colspan=\"3\"><a href=\"https:\/\/www.regulations.gov\/document\/FTC-2025-0264-0001\"><strong>Federal Trade Commission Request for Information on Gender Affirming Care Practices<\/strong><\/a>, July 28, 2025.<span style=\"font-size: 20px;font-family: inherit;font-weight: inherit;letter-spacing: 0px\">&nbsp;<\/span><\/td><td style=\"vertical-align:top\"><\/td><\/tr><tr><td style=\"vertical-align:top\"><strong>Purpose:&nbsp;<\/strong>The Federal Trade Commission (FTC) issued a request for public comment on \u201chow consumers may have been exposed to false or unsupported claims about \u2018gender-affirming care\u2019(GAC), especially as it relates to minors, and to gauge the harms consumers may be experiencing.\u201d<br><br>Arguing that GAC has been subject to \u201cpotential deceptive or unfair practices involved in this type of medical care,\u201d the agency \u201cseeks to evaluate whether consumers (in particular, minors) have been harmed by GAC and whether medical professionals or others may have violated Sections 5 and 12 of the FTC Act by failing to disclose material risks associated with GAC or making false or unsubstantiated claims about the benefits or effectiveness of GAC.\u201d<br><br>As discussed in the RFI, this action comes on the heels of a recent <a href=\"https:\/\/www.ftc.gov\/news-events\/events\/2025\/07\/dangers-gender-affirming-care-minors\">workshop<\/a> the agency held on the same topic and the agency now seeks comment related to:<br><br>\u2022 Experiences of individuals and families seeking GAC, including on recommendations made by providers, whether providers described risks\/benefits\/effectiveness, and whether providers discussed the current policy environment and debates related to GAC, among other issues.<br><br>\u2022 Whether GAC was obtained and whether individuals experienced benefits\/side effects\/adverse events, among other issues.<br><br>\u2022 Detail related to whether providers \u201cmade false representations regarding the benefits or effectiveness.\u201d<br><br>\u2022 Information related to providers making \u201cfalse representations regarding the benefits or effectiveness\u201d related to GAC<\/td><td style=\"vertical-align:top\"><strong>Implications:&nbsp;<\/strong>This activity is likely to have a chilling effect on provider willingness to offer GAC. In addition to the workshop and RFI described above, more than 20 providers have <a href=\"https:\/\/www.justice.gov\/opa\/pr\/department-justice-subpoenas-doctors-and-clinics-involved-performing-transgender-medical\">received subpoenas<\/a> from the DOJ for investigations related to GAC that \u201cinclude healthcare fraud, false statements, and more.\u201d<br><br>The RFI (and surrounding actions) also have the potential to promote misinformation around the risks and benefits of GAC and suggests that providers are using deceptive and unethical positions in delivering GAC on a significant scale, something that has not been demonstrated. Additionally, the RFI states that there is \u201cwidespread concern about the harms\u201d related to GAC but does not acknowledge the broad clinical support GAC has as medically necessary treatment for gender dysphoria, including from major U.S. medical associations.<\/td><td style=\"vertical-align:top\"><\/td><\/tr><tr><td style=\"vertical-align:top\"><a href=\"https:\/\/www.whitehouse.gov\/presidential-actions\/2025\/08\/improving-oversight-of-federal-grantmaking\/\"><strong>Improving Oversight of Federal Grantmaking<\/strong><\/a>, August 5, 2025<\/td><td style=\"vertical-align:top\"><\/td><td style=\"vertical-align:top\"><\/td><\/tr><tr><td style=\"vertical-align:top\"><strong>Purpose: The Executive Order seeks reform \u201cthe process of Federal grantmaking while ending offensive waste of tax dollars.\u201d<\/strong><br><br>The EO aims to overhaul the federal grantmaking and grant review process \u201cto strengthen oversight and coordination of, and to streamline, agency grantmaking to address these problems, prevent them from recurring, and ensure greater accountability for use of public funds more broadly.\u201d &nbsp;One section of the EO requires agencies to \u201censure that\u2026[grants] are consistent with agency priorities and the national interest.\u201d In addition to other actions, agencies are directed to ensure that awards are not \u201cused to fund, promote, encourage, subsidize, or facilitate\u201d certain themes including, \u201cdenial by the grant recipient of the sex binary in humans or the notion that sex is a chosen or mutable characteristic\u201d and \u201cracial preferences or other forms of racial discrimination by the grant recipient, including activities where race or intentional proxies for race will be used as a selection criterion for employment or program participation,\u201d among others.<\/td><td style=\"vertical-align:top\"><strong>Implications:&nbsp;<\/strong>This approach to grantmaking could further chill research and grantmaking related to and aimed to supporting transgender and gender diverse people, including that related to health and healthcare. This could impact access to and availability of culturally competent services at the individual level and reduce research and data on transgender and gender diverse communities more broadly. Such research in turn could have been used to inform service delivery and policy making and to address health disparities.<\/td><td style=\"vertical-align:top\"><\/td><\/tr><\/tbody><\/table>\n<\/div>\n\t<div class=\"post-footer\">\n\t<div class=\"post-footer__title\">More On<\/div>\n\t<div class=\"post-footer__links\">\n\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.kff.org\/topic\/lgbtq\/\">\n\t\t\t\tLGBTQ\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.kff.org\/topic\/other-health\/\">\n\t\t\t\tOther Health\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.kff.org\/tag\/access-to-care\/\">\n\t\t\t\tAccess to Care\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.kff.org\/tag\/courts\/\">\n\t\t\t\tCourts\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.kff.org\/tag\/gender-identity\/\">\n\t\t\t\tGender Identity\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.kff.org\/tag\/sexual-orientation\/\">\n\t\t\t\tSexual Orientation\t\t\t<\/a>\n\t\t\t<\/div>\n<\/div>\n\t\t\t<\/div>\n\t<\/section>\n\n\n\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>This tracker examines Executive Actions taken by the Trump administration that have the potential to impact LGBTQ+ people\u2019s health. It lists the action taken by date, provisions relevant to LGBTQ+ health, and describes potential impact, including litigation challenging these actions.<\/p>\n","protected":false},"author":155412881,"featured_media":654445,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"authors":[{"type":"foundation","id":127159,"name":""},{"type":"foundation","id":49444,"name":""}],"exhibits":[],"jetpack_post_was_ever_published":false,"ep_exclude_from_search":false,"_classifai_error":"","_classifai_text_to_speech_error":"","hide_from_search":false,"show_featured_image":false,"subheading":"","tag":"","search_keywords":"Fact Sheet, 10599, Lindsey Dawson, Jennifer Kates","_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"shortlink":"","footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"enabled":false},"version":2}},"categories":[417697712,1035],"tags":[632330,9862,155118268,579145448],"series":[],"partner":[],"content-types":[579145485,579145492],"program":[],"class_list":["post-654315","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-lgbtq","category-other-health","tag-access-to-care","tag-courts","tag-gender-identity","tag-sexual-orientation","content-types-fact-sheet","content-types-tracker"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v25.9 (Yoast SEO v25.9) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Overview of President Trump\u2019s Executive Actions Impacting LGBTQ+ Health | KFF<\/title>\n<meta name=\"description\" content=\"This tracker examines Executive Actions taken by the Trump administration that have the potential to impact LGBTQ+ people\u2019s health. 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