Trump Administration Targets Major LGBTQ+ Health Care Centers In Latest Legal Attack

The administration has referred four clinics: Callen-Lorde, LA LGBT Center, The Institute for Family Health, and Whitman-Walker for investigation.

Whitman-Walker // Lubert-Adler

Trump's attacks on transgender health care have accelerated at a blistering pace. Using dubious legal authority and threats to hospital funding, he has unilaterally acted to shut off care by fiat alone, unconnected to any law passed by Congress. Hospitals, by and large, have capitulated to the administration rather than fight to maintain their care programs. Now, the administration has unleashed its latest attack: not on gender clinics attached to children's hospitals, but on LGBTQ+ health centers themselves, with an investigation announced by HHS General Counsel Mike Stuart.

In a post on Twitter on Wednesday, HHS General Counsel Mike Stuart announced that four federally qualified health centers would be referred to the HHS Office of Inspector General for investigation: Whitman-Walker Health in Washington, D.C.; Community Health Project, also known as Callen-Lorde, in New York City; the Los Angeles LGBT Center; and the Institute for Family Health in New York City. Stuart wrote:

The @ASPS_News and AMA have made strong statements on this critical issue. The evidence is clear—sex rejecting procedures for children are not acceptable standards of healthcare. In just the past few weeks, more than 40 hospital systems across the country have made the right decision to stop these heinous procedures. But there is far more work to do to protect our children. Today, unfortunately, I made additional referrals for investigation to @OIGatHHS. These referrals are not for hospitals but, rather, for federally qualified health centers (FQHCs).

The referrals are the latest in the rapidly escalating campaign by the Trump administration to strongarm every institution where transgender youth receive care into ending that care. The investigations stem from a Dec. 18 declaration by HHS Secretary Robert F. Kennedy Jr., which stated that any medical organization providing what it called "sex-rejecting procedures" for transgender youth could be excluded from participating in Medicare and Medicaid through a process called a "notice of exclusion." The declaration asserts that the secretary can abolish an institution's participation in these federal payment programs if the institution "fails to meet professionally recognized standards of health care,” a death sentence for most clinics and hospitals.

The latest referrals lean on what Stuart says are statements from the American Society of Plastic Surgeons and the American Medical Association opposing "sex-rejecting procedures" as justification for meeting the "professionally recognized standards of health care" threshold. But neither organization used the term "sex-rejecting procedures.” The ASPS statement explicitly says it is not a "clinical practice guideline,” meaning it has not undergone a formal guideline development process, rather, it is only a position statement. And the AMA, while stating that surgical interventions in minors should be "generally deferred to adulthood," stressed that it still supports access to gender-affirming care for young people, including puberty blockers and hormone therapy. Even for surgeries, the word "generally" allows for exceptions—mainly around chest surgery in the case of severe dysphoria in older transgender teens, consistent with longstanding clinical practice. Neither statement changed the actual standards of care.

The latest referrals also appear to violate, at least in spirit, the agreement in Oregon v. Kennedy, where 22 states filed a lawsuit challenging the Kennedy Declaration as violating the Administrative Procedure Act. In that lawsuit, HHS agreed to pause exclusion notices, but referrals for investigation continue. Furthermore, in HHS's opposition to the states' motion for summary judgment, the administration argued that the Kennedy Declaration is merely a nonbinding policy view—and is not being used to target providers or set a new standard of care. But Stuart himself specifically boasts about shutting down 40 clinics in his tweet. The administration is caught in what amounts to a Schrödinger's paradox: telling the court the declaration is not actually being used to exclude anyone or establish a binding standard, while simultaneously wielding the threat of investigation and exclusion to pressure providers into abandoning care. They know the declaration does not need to be formally enforced to be effective—all they need to do is threaten and many hospitals will choose to capitulate rather than fight.

It remains to be seen how these LGBTQ+-focused health centers respond to the threats. While many children's hospitals have shut down gender-affirming care programs, this latest campaign appears targeted directly at LGBTQ+ centers themselves—organizations built to serve LGBTQ+ populations, including transgender youth. While most LGBTQ+ centers have fought back against the Trump administration, at least one, Fenway Health in Boston, chose to capitulate. The communities these centers serve will be watching their actions closely in the coming days.