From Children to Adults: The Government’s Expanding Attack on Gender-Affirming Care

For hospitals, health systems, Ryan White HIV/AIDS Program grantees, and other federally funded health care providers, the line between pediatric and adult restrictions on gender-affirming care is eroding. Enforcement tools built around children's care are now reaching adult patients, adult providers, and the public health infrastructure that serves people living with HIV.

In a recent article published by Health Affairs Forefront, Richard H. Hughes IV, Member of the Firm of Epstein Becker Green and counsel to health care and life sciences clients on health policy and government enforcement matters, Eric J. Neiman, Member of the Firm and counsel to health systems on regulatory compliance and crisis management, Jennifer Nelson Carney, Member of the Firm and counsel to hospitals and health systems on provider operations and patient care compliance, and Julia Rioux Thayer, Associate and counsel to health care organizations on health care litigation and administrative law, examined how the administration's campaign against gender-affirming care is moving beyond pediatric medicine into adult care.

The authors traced the pattern from the Centers for Medicare & Medicaid Services' August 2026 decision to end Medicaid and Children's Health Insurance Program funding for pediatric gender-affirming care to a broader set of tools now reaching adults, including restrictions on federal employee health coverage, curtailed access in federal prisons, Federal Trade Commission civil investigative demands against provider organizations, and state Medicaid exclusions.

The centerpiece of the article is the Ryan White HIV/AIDS Program, which funds care for people living with HIV, including transgender patients for whom gender-affirming care can support engagement in HIV treatment. The authors described how the Health Resources and Services Administration's updated grant terms condition funding on certifications tied to Title IX and gender-identity executive orders, exposing recipients to False Claims Act liability, and detailed the resulting lawsuit by the American Academy of HIV Medicine, now headed to a bench trial in September 2026. “The distinction between prohibiting gender-affirming care for minors and restricting gender-affirming care for adults is no longer holding,” the authors wrote.

Get in Touch

To discuss how these enforcement trends may affect your organization's Ryan White funding, Medicaid participation, or other federal grant compliance obligations, contact Richard H. Hughes IV at RHHughes@ebglaw.com, Eric J. Neiman at eneiman@ebglaw.com, Jennifer Nelson Carney at JNelsonCarney@ebglaw.com, or Julia Rioux Thayer at jthayer@ebglaw.com.