Judge Rules HHS Can’t Halt Federal Payments To Clinics That Perform ‘Sex-Rejecting Procedures’

A federal judge ruled that HHS Secretary Robert F. Kennedy Jr.’s declaration that “sex-rejecting procedures” are unsafe and ineffective for children did not follow proper procedures. Judge Mustafa T. Kasubhai said that Secretary Kennedy’s declaration, although a non-binding opinion, served as a coercive tactic and thus operated as a rule without following the proper rulemaking protocol. Judge Kasubhai issued a March ruling temporarily vacating the declaration and has now permanently vacated it.

HHS has been finalizing a rule that would end Medicare and Medicaid payments to facilities that provide “sex rejecting” or “gender affirming” procedures to minors based on the evidence from the Cass Report and the peer-reviewed HHS report released in September. Judge Kasubhai extended his ruling barring HHS from pursuing these options and said the agency lacks the authority to supersede the standard of care set by the state.

The declaration made by Secretary Kennedy in December 2025 states, “Sex-rejecting procedures for children and adolescents are neither safe nor effective as a treatment modality for gender dysphoria, gender incongruence, or other related disorders in minors, and therefore, fail to meet professional recognized standards of health care.”

The Trump administration argued that the rule was not being enforced. The Center for Medicare and Medicaid Services (CMS) submitted official rules to halt federal funding to health care institutions that provide “sex-rejecting” or “gender-affirming” treatments to children. The comment periods for those rules ended in February and haven’t yet been finalized. The latest ruling by Judge Kasubhai will likely hold up these rules from taking effect.

Hospitals and clinics have been halting their gender care programs for minors since the Trump administration has been implementing policies that align with President Trump’s executive order to “protect children from chemical and surgical mutilation.” The latest ruling might enable some of these clinics to reopen their programs as the administration attempts to find a new way to encourage the end of “sex rejecting” procedures for minors.

Judge Kasubhai’s ability to fulfill his role as an objective federal judge was called into question during his 2023 Senate confirmation hearing after he was nominated by President Biden. Senator Tom Cotton said Kasubhai is not a reasonable nominee. “He is not even one of the run-of-the-mill crazy left-wing nominees,” Cotton said. “He is uniquely unqualified to be a federal judge.”

One particular statement that Senator Cotton and others took issue with was one Kasubhai made in an interview. In 2021, he said, “We have to set aside conventional ideas of proof when we are dealing with the personal and interpersonal work of equity, diversity, and inclusion. As a judge, I can appreciate the challenge of employing a different mode for understanding truth than that which most lawyers are accustomed to in our work.”

In addition to that statement, Kasubhai’s potential bias has been noted as he wrote an essay in 2021 where he reflected upon his privilege as a “cisgender man.” In the essay, he explains how he learned from a lawyer that he should not be referring to “preferred pronouns” because it assumes that pronouns other than the ones listed are acceptable. Kasubhai also founded the Oregon Mediator Diversity Project, which states that there is historic systemic discrimination against diverse groups, including those with varied gender expression or gender identity.

Kasubhai, in his ruling, referred to Secretary Kennedy’s leadership as “unserious” and “unsafe.” He further said that Kennedy’s declaration caused “chaos and terror.” He said that Kennedy acted with “cruelty” and “harmed children.” Judge Kasubhai said the Trump administration has wielded Kennedy’s declaration to bully medical providers and prevent them from providing “life-saving care” to children.

During Supreme Court arguments on Tennessee’s gender affirming care ban, ACLU attorney Chase Strangio admitted that there is no evidence that gender affirming care reduces suicide after Justice Alito referred to the Cass Review that came to the same conclusion. Strangio said suicide is “admittedly rare” and that this type of care reduces suicidality.

The HighWire reported earlier this month about a long-term Finnish study that found gender affirming care increased psychiatric morbidity for both groups (male to female and female to male) compared to the control group. There was a 6-fold increase in those who needed psychiatric care after receiving feminized treatment compared to before they received the treatment. There was a 2.5-fold increase for masculinized treatments. Specialist-level psychiatric care is only available for accepted referrals and indicates severe mental disorders in Finland.

The study did not measure suicidality specifically, but there is a well-documented association between suicidality and mental health disorders. A 2002 review on suicide and psychiatric disorders published in World Psychiatry states, “It is generally acknowledged that over 90% of those who committed suicide had a psychiatric diagnosis at the time of death.”