HHS Rescinds Guidance on Gender Affirming Care for Minors

On Feb. 20, 2025, the U.S. Department of Health and Human Services (HHS) rescinded its guidance on gender-affirming care from March 2, 2022, effective immediately. HHS was directed to rescind this guidance by President Donald Trump’s Executive Order 14187 (“Protecting Children from Chemical and Surgical Mutilation”). According to HHS, the 2022 guidance no longer reflects its views, and the rescission is a significant step in aligning civil rights and health information privacy enforcement with the Trump Administration’s policies.

Highlights

• HHS has rescinded guidance it issued in 2022 regarding the application of federal civil rights and patient privacy laws to gender-affirming care for minors.
• HHS was directed to rescind this guidance by a Trump administration executive order.
• While this development demonstrates HHS’ views on this topic, it does not affect any final regulations or court decisions.

Rescinded Guidance from 2022

The 2022 guidance stated that transgender medical interventions may improve both physical and mental health outcomes for minors and outlined the application of federal civil rights and patient privacy laws to such medical treatments for minors in the following three ways:

1. Section 1557: Section 1557 of the Affordable Care Act prohibits discrimination based on race, color, national origin, sex, age or disability in health programs and activities that receive federal funding. The 2022 guidance stated that Section 1557 prohibits discrimination based on gender identity in federally funded health care settings.
2. Disability Discrimination Protections: The 2022 guidance stated that gender dysphoria may qualify as a disability under Section 504 of the Rehabilitation Act, which protects individuals with disabilities from discrimination in programs and activities that receive federal financial assistance. This guidance noted that restrictions that prevent otherwise qualified individuals from receiving medically necessary care on the basis of their gender dysphoria, gender dysphoria diagnosis, or perception of gender dysphoria may violate Section 504 or Title II of the Americans with Disabilities Act.
3. Patient Privacy: The 2022 guidance emphasized that health care providers and other covered entities cannot disclose protected health information about gender-affirming care without patient authorization, except in limited circumstances where required by law.

Basis for Rescission

HHS explained that it rescinded the 2022 guidance on the application of Section 1557 to gender identity because the legal basis for this interpretation has been called into question by several court decisions. Also, HHS noted that gender dysphoria likely does not meet the definition of disability under Section 504 of the Rehabilitation Act. Further, HHS explained that the patient privacy provisions in the 2022 guidance lack adequate legal basis under federal privacy laws, including the HIPAA Privacy and Security Rules.

HHS plans to issue new guidance protecting whistleblowers who take action related to ensuring compliance with this new order.  

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