Eighteen Democratic state attorneys general and one Democratic governor have joined to file a lawsuit challenging the Trump administration’s attempt to limit access to gender-affirming care for trans youth. Last Thursday, Health and Human Services Secretary Robert F. Kennedy Jr. issued a declaration saying what he called “sex-rejecting procedures” 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.” This includes surgery, cross-sex hormones, and puberty blockers. The position is contrary to the position of every major medical association in the U.S. HHS also threatens to exclude providers of such care from the federal Medicare and Medicaid programs, even if the care was not covered under those. Related: What is gender-affirming care, who uses it, and do they regret it? The coalition that filed the suit is led by Oregon Attorney General Dan Rayfield. Under a law passed in 2023, Oregon requires insurers to cover medically necessary gender-affirming procedures and protects both patients and providers from out-of-state legal challenges. “By targeting Oregon providers, HHS is putting care at risk and forcing families to choose between their personal health care choices and their doctor’s ability to practice,” Rayfield said in a press release . “Health care decisions belong with families and their health care providers, not the government.” “The Kennedy Declaration exceeds the Secretary’s authority and violates the Administrative Procedure Act and the Medicare and Medicaid statutes,” says the lawsuit , filed Tuesday in U.S. District Court in Oregon. “The Kennedy Declaration is procedurally defective. At minimum, Secretary Kennedy and HHS cannot circumvent statutorily mandated notice and comment requirements by changing substantive legal standards by executive fiat.” “Congress has not given the Secretary the authority to define the professionally established standard of care,” it continues, adding that “Congress expressly prohibits ‘any Federal officer … to exercise any supervision or control over the practice of medicine.’” The suit names as defendants HHS, its inspector general’s office, Inspector General Thomas March Bell, and Kennedy. If federal officials wish to change policy through the rulemaking process, they have to follow certain procedures and provide 60 days for public comment before the rules can go into effect, the suit notes. At the same time Kennedy issued the declaration, HHS proposed rules barring any hospital from providing gender-affirming health care to trans youth from participating in Medicare and Medicaid, and prohibiting Medicaid funds from covering gender-affirming care for trans people under 18 and Children’s Health Insurance Program funds from covering such care for trans people under 19. These rules have not gone into effect yet, and HHS has given the public until February 17 to submit comments, so they are not part of the suit. Also, the U.S. House has passed a bill that would criminalize gender-affirming care for trans youth, but it may not get through the Senate. Related: Health policy expert to RFK Jr.: You can't ban trans youth care this way The Kennedy declaration, the suit says, harms trans youth and their families as well as health care providers, and it puts state Medicaid programs at risk. The suit asks the court to rule the declaration unlawful and permanently block its enforcement. Rayfield is joined in the suit by Gov. Josh Shapiro of Pennsylvania and these attorneys general: Nicholas W. Brown of Washington State , Letitia James of New York, Rob Bonta of California , Philip J. Weiser of Colorado , William Tong of Connecticut , Kathleen Jennings of Delaware , Brian L. Schwalb of the District of Columbia , Kwame Raoul of Illinois , Aaron M. Frey of Maine , Anthony Brown of Maryland , Andrea Joy Campbell of Massachusetts , Dana Nessel of Michigan , Keith Ellison of Minnesota , Matthew J. Platkin of New Jersey , Raúl Torrez of New Mexico , Peter Neronha of Rhode Island , Charity Clark of Vermont , and Joshua Kaul of Wisconsin . “Secretary Kennedy’s declaration seeks to advance Trump’s campaign against transgender Americans by attempting to limit access to gender-affirming care for minors,” Bonta said in a press release . “The declaration aims to bully hospitals into halting this crucial care. It's unlawful, circumventing mandatory notice and comment requirements. With today’s lawsuit, we are once again holding the Trump Administration accountable for overstepping its authority and violating federal law, ensuring transgender individuals are able to receive the care they need.” “Trump and RFK Jr. are forcing a radical political agenda on doctors and families and weaponizing Medicare and Medicaid funding to deny health care to kids,” said a statement from Tong. “These extreme actions threaten to decimate medical providers nationwide unless they end gender-affirming care, supplanting medical expertise and parental choice with MAGA ideology. This is cruel and lawless, and we’re suing to block them.”