On September 2, 2026, a coalition of 21 state attorneys general and one governor sued the Department of Health and Human Services in federal court in Massachusetts, seeking to block a rule that would end federal Medicaid and CHIP reimbursement for gender-affirming care for minors. California Attorney General Rob Bonta co-led the filing with the attorneys general of Illinois, Maryland, Connecticut, and Massachusetts.
The rule bars federal reimbursement for puberty-delaying medication, hormone therapy, and surgical treatment of gender dysphoria for patients under 18 under Medicaid and under 19 under CHIP. HHS announced it in December 2025 and finalized it in August 2026. It takes effect October 13, 2026 unless a court intervenes.
The states make four arguments, and they are administrative rather than primarily about the merits of the underlying care. They say the rule oversteps HHS's authority and violates separation of powers by regulating the practice of medicine, which is reserved to the states. They say HHS failed to justify it adequately and “cherry-picked evidence.” They say excluding care a state has deemed medically necessary conflicts with the Social Security Act and with HHS's own precedent. And they say HHS has no authority to prohibit Medicaid or CHIP coverage of essential medical services that comply with state law.
Bonta said, “HHS has disregarded the law and its own policy precedent in another attempt to restrict transgender individuals' access to crucial care.”
What is genuinely contested here should be stated rather than assumed. The medical question, how and whether to treat gender dysphoria in minors, is disputed among clinicians internationally, and several European health systems have narrowed their own protocols after evidence reviews. The legal question in this case is narrower: whether a federal agency can bar states from spending Medicaid dollars on care those states have determined to be medically necessary, and whether it followed the required process in doing so. A court can rule for the states without reaching the medical dispute at all.
This is the second such suit. In December 2025, 19 states and the District of Columbia sued over the earlier announcement; this filing challenges the finalized rule.