Washington Attorney General Criticizes Federal Strategy on Gender-Affirming Care for Minors

Washington State’s attorney general has publicly criticized recently proposed federal regulations aimed at restricting gender-affirming medical care for minors. The dispute highlights a broader tension between state authority over health policy and federal efforts to regulate medical treatments funded by public programs.

The U.S. Department of Health and Human Services (HHS) announced rules in December 2025 that would deny Medicare and Medicaid funding to hospitals and clinics providing gender-affirming care to individuals under 18. These treatments include hormone therapies and certain surgical interventions. Federal officials frame the measure as a safeguard for minors, while critics argue it overreaches both medical practice standards and state authority.

Attorney General Nick Brown responded with a public statement emphasizing that, under Washington law, gender-affirming care remains lawful and protected when deemed clinically appropriate. He noted that the federal regulations are still in draft form, subject to public comment and potential legal challenge.

Legal and Institutional Context

The proposed rules follow an executive order issued earlier in 2025 directing HHS to limit federal funding for gender-affirming care for minors. If finalized, these rules would affect not only federal programs but also state Medicaid coverage, potentially limiting reimbursement for care that is legally permitted at the state level.

Washington has previously challenged similar federal actions in court. In February 2025, Attorney General Brown filed a lawsuit against an executive order that sought to block federal funding for gender-affirming care. The suit contended that the order violated constitutional protections by singling out a particular group and exceeding the limits of executive authority. A federal judge granted a preliminary injunction, blocking the enforcement of the order in Washington while litigation continues.

State Perspective and Practical Implications

In defending Washington’s policies, Brown’s office underscored that medical decisions should be guided by clinical judgment and state law, rather than determined unilaterally by federal regulation. The attorney general highlighted concerns about federal overreach, particularly when funding restrictions could effectively dictate medical practice.

Healthcare providers in Washington have already experienced consequences from the uncertainty surrounding federal proposals. Some institutions offering gender-affirming care for minors have reduced or paused services, citing the financial risk posed by potential funding losses. This illustrates how even proposed regulations, not yet in effect, can influence the delivery of medical care.

Medical and Professional Perspectives

Leading medical associations, including the American Medical Association and the American Academy of Pediatrics, generally recommend gender-affirming care for minors when clinically appropriate. Research cited by these organizations indicates improved mental health outcomes when care is tailored to individual needs. The federal proposals, in contrast, characterize such care as inappropriate for minors, reflecting a more restrictive stance than professional guidance suggests.

Proponents of the federal rules argue that caution is warranted when treating minors and that the measures protect children from potential harm. Critics counter that restricting access undermines the doctor-patient relationship and places government between families and qualified medical professionals. Both sides have indicated intentions to engage in formal regulatory procedures or pursue litigation.

Current Status and Outlook

As of December 2025, the federal rules remain in draft form and must undergo formal notice-and-comment procedures. Washington’s attorney general has indicated that legal responses are under review, while existing court orders continue to prevent enforcement of earlier federal actions. The ongoing debate is likely to raise questions about the limits of executive authority, state oversight of medical practice, and the interplay between federal funding and health policy.

Measured Takeaway

The dispute over gender-affirming care for minors reflects enduring challenges in American governance: balancing federal oversight with state authority, protecting access to medically appropriate care, and resolving complex legal and ethical questions. As the issue proceeds through administrative and judicial channels, policymakers, healthcare providers, and the public will watch closely, with implications not only for treatment availability but also for the broader structure of health policy in a federal system.