AG Letitia James Just Stood Up For Trans Youth In New York. Now, Will Mayor Mamdani Act?

Attorney General Letitia James has demanded NYU Langone restart care for transgender youth. Will NYC Mayor Mamdani act as well?

AG’s Office

In the last month, two major hospitals in New York City—NYU Langone and Mount Sinai—have ended their gender-affirming care programs for patients under 19. The decisions are acts of cowardice and capitulation to the Trump administration, and they violate state civil rights law in the process, given that Trump's threats against the hospitals are not law. In the immediate aftermath, Democratic politicians across the state with real power to force the hospitals back into compliance failed to act. But that changed last night. Attorney General Letitia James ordered NYU Langone to resume care or face legal action. It is good to finally see action protecting transgender youth in the state. Now, it remains to be seen if Mayor Mamdani will follow suit and use the tools available to him to return care to the trans youth affected.

"NYU Langone's change in policy is self-imposed; there has been no change in federal law to require the cessation of medically necessary transgender healthcare," says the AG in a letter to NYU Langone. "In sum, no federal action has changed the law; medically necessary healthcare for transgender adolescents remains legal and covered by federal programs. Without a formal change in the law, meaning an action from which legal consequences will flow, such as a published final rule upheld by the courts, NYU Langone's legal obligations to its patients are unchanged," the letter continued, giving the hospital 10 days to comply or face legal consequences.

This is not the first time James has used legal threats against the hospital. In February 2025, after NYU Langone canceled appointments for trans youth patients following Trump's executive order, James threatened to sue, warning that refusing care to trans patients while continuing it for cisgender patients constituted discrimination under state law. Thousands protested outside NYU Langone's Tisch Hospital. NYU Langone quietly reinstated appointments, though some patients reported being blocked from advancing their care beyond its current stage. The hospital never issued a public statement acknowledging the reversal.

The latest showdown comes after the Trump administration proposed rules in December that would strip Medicare and Medicaid funding from any hospital that provides gender-affirming care to patients under 18. The threat has proven effective in scaring hospitals into compliance—more than 40 nationwide have now paused or ended some form of gender-affirming care for minors. But the proposed rules are not law. The public comment period closed on February 17, final rules are not expected until spring at the earliest, and the rules themselves likely violate federal statute. Section 1801 of the Social Security Act explicitly bars the federal government from using Medicare or Medicaid regulations to control the practice of medicine, stating: "Nothing in this title shall 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."

Now that AG James has acted, many wonder if Mayor Mamdani will follow suit. The mayor ran on a sweeping promise to protect transgender healthcare—pledging $65 million in public investment, direct provision of care through the city's public hospital system, and aggressive enforcement of city human rights law against hospitals that pre-comply with Trump's demands. Now faced with his first major crisis targeting transgender people, however, his office has been largely silent. The mayor posted a statement on social media on February 19 calling NYU Langone's decision "yet another example of a private institution capitulating to the federal government's assault on transgender rights" and pledging that "New York City will continue to be a refuge for the LGBTQIA+ community." But he has not used any of the concrete tools at his disposal to bring care back, many of which do not require substantial investment. He has stayed completely quiet on whether his office is even in the process of taking steps to provide care for trans youth affected by the closures, even though he has a substantial set of tools to do so—and even though his own campaign platform was built around using them.

Among the most powerful tools at his disposal: Mamdani can immediately direct NYC Health + Hospitals, the largest public hospital system in the country, to absorb transgender youth displaced by the NYU Langone and Mount Sinai closures. The system operates 11 hospitals and more than 70 community-based health centers across all five boroughs, employs more than 42,000 people, serves over a million New Yorkers annually, and runs on a budget of roughly $10 billion. It already has eight Pride Health Centers. The mayor controls the H+H board. And the system has proven it can move fast: in January, Mamdani himself stood alongside H+H leadership to announce two new youth clinics at Woodhull and Queens, funded with $4 million from MetroPlusHealth, the system's own managed care plan. The number of transgender youth who would need to be absorbed from NYU Langone and Mount Sinai is a rounding error in a system of this size. A directive from the mayor's office to ensure H+H facilities are actively accepting these patients and connecting displaced families with care would cost little—and it has not come.

Mamdani also has significant tools with respect to city human rights law enforcement. The NYC Commission on Human Rights, which falls under the mayor's administration, can levy civil penalties of up to $125,000 per violation of the city Human Rights Law and up to $250,000 for conduct found to be willful or malicious—and can order policy changes. The Commission filed its own complaints against both NYU Langone and Mount Sinai on February 27, 2025—over a year ago—for denying gender-affirming care to new youth patients, and both cases remain listed as "open" with no fines levied and no enforcement actions announced. Mamdani's office could coordinate with Attorney General James and district attorneys to jointly investigate hospitals that deny trans youth care and to hold public hearings. There is nothing stopping the mayor from directing his own enforcement agency to move with urgency on its year-old cases, from pursuing parallel action under city law to reinforce the AG's order, or from making the same legal threats James is making—under the city's own anti-discrimination statute, with its own penalties.

Erin in the Morning has submitted repeated requests for comment to the mayor's office over the last two weeks asking whether the administration is taking any steps at all to restore care for transgender New Yorkers. The mayor's office has not responded to repeated requests for comment on whether he will act to restore care. NYC Health + Hospitals has not responded to repeated questions about whether the system would absorb patients displaced by the NYU Langone and Mount Sinai closures. The NYC Commission on Human Rights has said only that it cannot comment on ongoing investigations in response to a request for comment. Transgender New Yorkers have heard very little from their mayor on a defining issue of his campaign—but at least now, one politician with real power is stepping up. Attorney General James has shown twice that legal pressure works on NYU Langone. It remains to be seen whether she will have to do it alone, or whether the mayor who promised to “use every single tool” will finally pick one up.