Federal Court Vacates Kennedy Declaration on Transgender Healthcare

April 20, 2026

Federal Court Strikes Down Kennedy Declaration on Transgender Healthcare

Dylan Nicole de Kervor, Mary Rohmiller, Alice Yao Potomac Law Group, PLLC + Follow Contact LinkedIn Facebook X ;) Embed On April 18, 2026, the United States District Court for the District of Oregon issued a sweeping opinion vacating the “Kennedy Declaration,” a directive issued by HHS Secretary Robert F. Kennedy, Jr. in December 2025 without notice-and-comment rulemaking. The Kennedy Declaration purported to establish that transgender healthcare for minors falls below professionally recognized standards of health care and threatened providers with exclusion from Medicare and Medicaid. Opinion and Order, State of Oregon, et al. v. Robert F. Kennedy, Jr., et al., No. 6:25-cv-02409-MTK (D. Oregon Apr. 18, 2026) (ECF 93).

The court granted summary judgment for the 22 Plaintiff States, vacated the Kennedy Declaration in its entirety, declared that HHS lacks authority to unilaterally establish standards of care superseding state-recognized standards, and permanently enjoined HHS and its Office of Inspector General (OIG) from implementing the Kennedy Declaration or any materially similar policy against any provider in the Plaintiff States.

This ruling delivers immediate, concrete protection to healthcare providers in Oregon, Washington, New York, California, Colorado, Connecticut, Delaware, the District of Columbia, Hawai’i, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, Pennsylvania, Rhode Island, Vermont, and Wisconsin. The court’s opinion—notable for its extraordinarily pointed criticism of the administration’s conduct as causing “very real harm to very real people”—found the Kennedy Declaration unlawful on multiple grounds.

Background

On December 18, 2025, Secretary Kennedy issued an agency declaration titled “Safety, Effectiveness, and Professional Standards of Care for Sex-Rejecting Procedures on Children and Adolescents” (Kennedy Declaration). The Kennedy Declaration stated that transgender healthcare for minors—including puberty blockers, cross-sex hormones, and surgeries—is “neither safe nor effective” and “fail[s] to meet professionally recognized standards of health care.” To support this declaration, the Secretary cited the definitional provision in an HHS OIG regulation—rather than a substantive rule—stating that practitioners who use treatment methods HHS considers unsafe “will be deemed not to meet professionally recognized standards of health care,” thereby exposing them to exclusion from all federal healthcare programs. That a mere regulatory definition could serve as the legal basis for such severe consequences—the potential loss of all Medicare and Medicaid funding—raises serious questions about the scope of the Secretary’s claimed authority.

HHS wasted no time implementing the Kennedy Declaration. Within eight days of its issuance, HHS General Counsel began publicly referring children’s hospitals to OIG for exclusion proceedings. By February 2026, HHS had referred at least seventeen providers, and more than forty hospital systems across the country had suspended transgender healthcare for minors in response to the threat of losing all federal healthcare funding.

A coalition of twenty-two states subsequently sued HHS under the Administrative Procedure Act (APA), including alleged violations of the Medicare Act’s rulemaking requirements and that the Declaration exceeded the Secretary’s statutory authority.

The Court's Holdings

The district court found the Kennedy Declaration unlawful on four independent grounds.

Violation of Medicare notice-and-comment requirements: The Medicare Act requires notice and an opportunity for public comment when a rule, requirement, or statement of policy establishes or changes a substantive legal standard governing provider eligibility. The court found that the Kennedy Declaration established a new substantive legal standard—that transgender healthcare for minors falls below professionally recognized standards of care—and that this standard directly governs provider eligibility for federal healthcare programs. HHS did not provide any notice-or-comment opportunity before issuing the Kennedy Declaration.

Violation of APA notice-and-comment requirements: Under the APA, legislative rules must go through notice-and-comment rulemaking. The court rejected the government’s argument that the Kennedy Declaration was merely a “general statement of policy” exempt from these requirements, finding that the Kennedy Declaration is a binding rule because it left OIG no discretion to reach any conclusion other than that providers of transgender healthcare to minors fail to meet professional standards.

Exceeds statutory authority: The Medicare statute expressly provides that it shall not be “construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided,” and states—not the federal government—serve as the primary regulators of professional medical conduct. The court found that Secretary Kennedy lacked authority to unilaterally declare an entire treatment method unsafe and ineffective or to supersede professionally recognized standards of care established at the state level.

Not in accordance with law: Federal law obligates HHS to pay for services covered under federally-approved state Medicaid plans, and each Plaintiff State’s plan includes coverage for transgender healthcare. The court held that the Kennedy Declaration violates this statutory obligation: by subjecting providers to exclusion for furnishing covered care without following statutory procedures, the Kennedy Declaration effectively attempted to amend approved Medicaid plans in violation of federal law.

The Court’s Criticisms of this Administration

The court’s opinion is notable for its pointed criticism of this administration. The court was particularly scathing in addressing the administration’s claim that finding the Kennedy Declaration unlawful would infringe Secretary Kennedy’s First Amendment rights, stating that it would not allow defendants to “bully or gaslight this Court into ignoring the many procedural and legal flaws of the Kennedy Declaration by invoking one of the most sacred principles of our constitutional democracy—the freedom of speech—when that principle comes nowhere close to being implicated.” The court found that the actual principles offended were “the rule of law and state sovereignty.”

The court also criticized the administration for characterizing the Kennedy Declaration’s devastating real-world consequences as unrelated to the Declaration itself. The court called this argument “ironic” given that HHS had publicly taken credit for forcing hospitals to suspend transgender healthcare, with HHS posting “It’s working” in response to news reports that hospitals had paused care, and the agency’s General Counsel boasting that “more than 30 hospitals and hospital systems” had stopped providing the care. The court observed that HHS had “sweepingly wielded the Kennedy Declaration to threaten children’s hospitals that provide life-saving care to children” and had “exploited the threat of exclusion to bully healthcare providers” into suspending care “out of fear they will lose federal healthcare program funding and the attendant ability to provide any life-saving care to all children.”

The court stated it could “scarcely recall an APA action” in which “the agency’s action was so clearly unlawful,” and noted this administration’s pattern of disregarding court orders, describing it as a “break it and see if they can get away with it” approach to administrative law. The court cited multiple cases in which other federal courts found this administration in violation of judicial orders, including instances in which courts described the administration’s conduct as “incredible, if not disingenuous.”

Remedies: Vacatur, Declaratory Judgment, and Permanent Injunction

The district court granted the full scope of relief requested by the plaintiffs. First, it vacated the Kennedy Declaration in its entirety, noting that vacatur is the “presumptive remedy for unlawful agency action.”

Second, the court declared that HHS lacks authority to unilaterally establish standards of care superseding those recognized in the Plaintiff States or to exclude providers from federal healthcare programs based on their provision of pediatric transgender healthcare in a manner consistent with those standards.

Third, the court permanently enjoined HHS and its OIG from enforcing, implementing, or relying on the Kennedy Declaration—or any materially similar policy—in any action against any provider in the Plaintiff States. The court found that this administration’s documented history of “evading or flouting prior court orders” left it with “no confidence that Defendants will adhere to the Court’s declaration” absent an injunction.

What This Means for Hospitals and States

Providers in Plaintiff States: The ruling provides immediate and direct protection to healthcare providers in the 22 Plaintiff States. HHS and its OIG cannot rely on the Kennedy Declaration—or any materially similar policy—to initiate exclusion proceedings against providers who furnish transgender healthcare to minors consistent with professionally recognized standards of care in those states. Providers who suspended transgender healthcare in response to the Kennedy Declaration should consult with counsel about resuming those services in light of this ruling.

Providers in Non-Plaintiff States: The injunction and declaratory relief are expressly limited to the Plaintiff States. However, the vacatur of the Kennedy Declaration has nationwide effect, as it sets aside the agency action itself. While this does not provide the same level of certainty as the injunction affords providers in the Plaintiff States, it offers meaningful legal protection. Providers outside the Plaintiff States should consult with counsel to evaluate the implications for their practices.

Potential for appeal: The government will likely appeal to the Ninth Circuit. If HHS obtains a stay pending appeal, the Kennedy Declaration could be temporarily reinstated. Appellate proceedings will be monitored closely.

Remaining claims: The Plaintiff States did not move for summary judgment on their fifth count, which alleges the Kennedy Declaration is arbitrary and capricious. That claim remains pending.

Related litigation to monitor: This ruling addresses the Kennedy Declaration only. It does not affect the separate DOJ directives at issue in Massachusetts v. Trump, Case No. 25-cv-12162 (D. Mass.), which threaten criminal and civil prosecution under the Female Genital Mutilation Act, the False Claims Act, and the Food, Drug, and Cosmetic Act. We recommend that providers continue to monitor that case—and consult with counsel—regarding potential DOJ enforcement exposure.

Key Takeaway

The Oregon v. Kennedy decision is a forceful rebuke of HHS’s attempt to unilaterally override state-recognized standards of care for pediatric transgender healthcare. The court found the Kennedy Declaration unlawful on every ground raised by the plaintiffs in their motion for summary judgment and imposed broad remedial relief, including a permanent injunction that extends beyond the Kennedy Declaration itself to cover any materially similar future policy. For providers in the Plaintiff States, this ruling eliminates the immediate threat of exclusion from federal healthcare programs based on the provision of transgender healthcare to minors. We will continue to track this case and related litigation and will provide updates as developments warrant.

;) ;) Report

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.
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