California Attorney General Rob Bonta led a coalition of state attorneys general and the Governor of Pennsylvania in filing a lawsuit on Friday challenging a U.S. Department of Health and Human Services rule on gender-affirming care.
The rule, set to take effect October 13, 2026, would prohibit federal Medicaid reimbursement for gender-affirming care for anyone under 18 in Medicaid and under 19 in the Children's Health Insurance Program (CHIP), according to the lawsuit.
In the lawsuit, the attorneys general argue that the HHS rule oversteps the agency's legal authority and lacks adequate evidence to justify restrictions on care that states have deemed medically necessary. The case was filed in the U.S. District Court for the District of Massachusetts.
The attorneys general contend in their arguments that the rule seeks to regulate the practice of medicine, which Congress reserved for states, and that HHS cherry-picked evidence to support its position while failing to consider evidence of the health benefits of gender-affirming care.
Bonta's office noted that even if the rule takes effect, providers can still legally offer gender-affirming care in California. Federal law does not prohibit the practice, and it is legal under California state law, according to the office. The rule does not prevent providers from offering gender-affirming care or penalize them for providing it, and expressly allows states to cover it using state-only funds.
The lawsuit was led by Bonta alongside attorneys general from Illinois, Maryland, Connecticut and Massachusetts. Other attorneys general joining the coalition represent Colorado, Delaware, the District of Columbia, Hawaii, Maine, Michigan, Minnesota, Nevada, New Jersey, New York, Oregon, Rhode Island, Vermont, Virginia, Washington and Wisconsin.