Rady Children’s Health, encompassing Children’s Hospital of Orange County, Rady Children’s Hospital San Diego and Rady Children’s in Riverside County, said the organization was recently referred for investigation to the U.S. Department of Health and Human Services Office of Inspector General.

The federal agency, which oversees the Medicare and Medicaid programs, did not comment about the timeline of its investigation or the focus of the probe Friday, saying HHS-OIG’s “general policy is to neither confirm nor deny the existence of an investigation.”

But patients at Rady Children’s and CHOC have been told they will no longer receive gender-affirming care at the facilities, which can include prescriptions for medications like puberty blockers, beginning on Feb. 6, according to advocates. As a result, patients going without medications like puberty blockers will not be able to see a doctor and have the specialized medical professional walk them through the process of going off the medication.

“The environment around gender-affirming care has changed dramatically, with escalating federal actions,” Rady Children’s Health said in a statement. “These developments affect our role and responsibilities as a provider participating in federal programs such as Medicaid and Medicare, which are essential to caring for all children and families in our communities.”

In December, HHS announced that the Centers for Medicare & Medicaid Services were proposing new rules that would ban gender-affirming care by medical providers that participate in its programs.

“Nearly all U.S. hospitals participate in Medicare and Medicaid and this action is designed to ensure that the U.S. government will not be in business with organizations that intentionally or unintentionally inflict permanent harm on children,” the department said at the time.

The department said that officials would also propose additional rules to prohibit Medicaid and other funding from being used for gender-affirming care for children or adults under the age of 19.

Rady Children’s Health said the decision to stop providing such medical interventions, procedures and prescriptions for patients was “very difficult” and “made to ensure we can continue serving all children and families across the communities we serve.”

LGTBQ+ advocacy organizations say the move is another example of continuous efforts by the Trump administration to mischaracterize legitimate care backed by major U.S. medical associations and erode access to services based in part on the false premise that transgender people do not exist.

Many hospitals across the country, including in California, have already pulled back on gender-affirming care or shuttered entire programs amid mounting pressure from the federal government.

In July, Children’s Hospital Los Angeles officially closed what had been among the largest and oldest pediatric gender clinics in the United States. For years the clinic had provided puberty blockers, hormones and other procedures for trans youth on public insurance.

This has forced transgender children and their families to relocate — sometimes to other states and out of the country — to seek medical care, said Brit Cervantes, the founder of OCGAPNet, an organization that advocates for trans rights.

“It’s a message that’s being sent that’s very clear: transgender people, and particularly transgender youth, don’t have a right to exist, and we don’t have a right to have access to healthcare,” Cervantes said. “All of this rhetoric that comes with these hostile policies is really damaging.”

OCGAPNet and Pride at the Pier, another Orange County-based organization, are holding a rally outside Children’s Hospital of Orange County in Orange at noon on Saturday to call for hospital leadership to resist federal pressure. TransFamily Support Services and the Alliance for TransYouth Rights are also holding a protest at 11 a.m. on Saturday outside the Rady Children’s Hospital in San Diego.

“This will not end with transgender kids,” said Kanan Durham, director of Pride at the Pier. “The administration is testing how easily they can force a hospital to betray its patients. They’re weaponizing their purse strings to tell us who can get care and who can’t.”

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The lawsuit, filed in the U.S. District Court for the District of Massachusetts, targets a January executive order that makes it U.S. policy not to “fund, sponsor, promote, assist, or support” gender transition for people under 19. The order threatens to pull federal funding from medical institutions that provide this type of care. 

“The result is an atmosphere of fear and intimidation experienced by transgender individuals, their families and caregivers, and the medical professionals who seek only to provide necessary, lawful care to their patients,” the attorneys general wrote in the suit.

This marks the 37th lawsuit California has filed against the Trump administration.

Gender-affirming care is legal and protected for people 18 years old and older in California. Certain treatments are also available to younger people with parental consent. The lawsuit comes as some of the largest medical providers in the state halt gender-affirming services.

The Trump administration has “trampled over state rights, overstepped their constitutional authority and endangered vulnerable minors and 18-year-olds,” Bonta said in a Friday press conference announcing the lawsuit alongside the attorneys general of Illinois and Connecticut. 

Providers scale back care

Following Trump’s executive order, the U.S. Department of Justice directed employees to investigate doctors, hospitals and pharmaceutical companies that provided gender-affirming care. In July, U.S. Attorney General Pamela Bondi announced in a statement that her department had issued more than 20 subpoenas to medical providers as it investigates “healthcare fraud, false statements and more.”

Responding to the suit, DOJ spokesperson Natalie Baldassarre said, “As Attorney General Bondi has made clear, this Department of Justice will use every legal and law enforcement tool available to protect innocent children from being mutilated under the guise of ‘care.’”

Bonta said that providers, fearing prosecution, have scaled back on providing gender-affirming care, which has left many patients without critical medical care, Bonta said. The care includes hormone therapy, puberty blockers and surgical procedures. Research shows that gender-affirming care can positively impact the mental health of transgender youth. Forcing young people to wait until they are 19 or older to start care allows symptoms of gender dysphoria to worsen, Bonta said.

The state attorneys general argue that acceding to Trump’s orders puts providers at odds with states’ anti-discrimination and age-of-majority laws. In California, it is illegal to deny care on the basis of gender identity and gender expression. At the same time, many medical providers rely heavily on federal funding in the form of research and education grants, as well as reimbursements from public payer programs like Medi-Cal.

The directives from the Trump administration have already forced several providers to suspend services. Last month, Children’s Hospital Los Angeles closed its gender-affirming care center, forcing about 3,000 patients under 21 to look elsewhere for care. 

“The shutdown came despite efforts my office took over recent months to assure (Children’s Hospital Los Angeles) that they were protected and required to provide gender-affirming care,” Bonta said.

Stanford Medicine has also paused surgical procedures for people under 19. And this week, Kaiser Permanente announced that it too would pause gender-affirming surgeries starting Aug. 29, noting that hormone therapies would still be available. 

The executive order being challenged is just one of several that Trump has issued targeting transgender people. Others include one that recognizes only two biological sexes, a second that prevents transgender girls and women from participating in women’s sports, and a third that threatens federal funds for schools that support transgender youth.

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