Image by Susana Cipriano from Pixabay

February 18, 2026 - OAKLAND — California Attorney General Rob Bonta yesterday joined a coalition of 21 attorneys general in submitting two comment letters opposing the U.S. Department of Health and Human Services’ (HHS) proposed rules that would deny certain federal funding for providers of gender-affirming care. The first letter opposes HHS’ proposal to prohibit federal reimbursement for gender-affirming care for minors in Medicaid and the Children’s Health Insurance Program (CHIP). The second letter opposes HHS’ proposal to prohibit healthcare facilities that provide gender-affirming care to adolescents from participating in Medicaid and Medicare. In the comment letters, Attorney General Bonta and the coalition argue that the rules violate states’ rights to regulate medicine, and that HHS has exceeded its legal authority in attempting to condition participation in federal programs on halting specific medical services. 

“The Trump Administration is trying to advance cruel and unlawful new rules that seek to deny transgender Americans access to crucial care,” said Attorney General Bonta. “The Trump Administration continues to overstep its authority in pursuit of a hateful agenda against transgender individuals’ rights. If HHS attempts to finalize rules that are similar to these proposals, we stand ready to use every tool in our toolbox to prevent them from ever going into effect. We are committed to defending California and other states’ rights to administer their healthcare programs. We will continue to fight to safeguard patients and their trusted healthcare providers from Trump’s baseless attacks.”

On December 18, 2025, HHS released Notices of Proposed Rulemaking for two proposed rules. The first rule (reimbursement rule) would stop Medicaid and CHIP from paying for medically necessary gender-affirming healthcare for anyone under the age of 18 under Medicaid and under the age of 19 under CHIP. The second rule (Conditions of Participation rule) would unlawfully prohibit healthcare facilities that provide medically necessary gender-affirming care from participating in the Medicaid and Medicare programs. The required period during which HHS must accept public comments on the proposed rules ended yesterday. HHS may publish final rules after reviewing the public comments, and the rules may become effective 60 days later, but only if no court blocks the final rules from going into effect. 

In yesterday’s comment letters, Attorney General Bonta and the coalition argue that:

• The reimbursement rule violates states’ legal rights to regulate medicine and hinders states’ abilities to administer Medicaid plans in accordance with state law.
• There is no legitimate legal basis for changing the conditions of participation in Medicaid or Medicare to prohibit a certain category of healthcare or specific medical services, as the Conditions of Participation rule seeks to do.
• States are granted the legal authority to determine what healthcare qualifies as medically necessary. HHS has exceeded its authority by attempting to condition provider participation in federal healthcare programs on those providers not offering certain medical services. 

California law, including the Unruh Civil Rights Act (Civil Code section 51) and Government Code section 11135, prohibit discrimination on the basis of sexual orientation or gender identity. Refusing services to a class of individuals based on their protected status, such as withholding services from transgender individuals based on their gender identity or their diagnosis of gender dysphoria, while offering such services to cisgender individuals, is discriminatory. Californians seeking gender-affirming care, and the doctors and staff who provide it, are protected under state law. Medi-Cal, California’s Medicaid program, covers gender-affirming care for minors. A full explanation of these rights and legal protections can be found in our Know Your Rights guidance here. 

Attorney General Bonta continues to stand firmly in support of healthcare policies that respect the dignity and rights of all people and has worked tirelessly to protect the LGBTQ+ community against unlawful threats from the Trump Administration. In January, he joined a coalition of 21 attorneys general in filing an amicus brief opposing the U.S. Department of Justice’s (U.S. DOJ) subpoena for patient records related to gender-affirming care from telemedicine platform QueerDoc. He joined similar multistate amicus briefs last year, opposing U.S. DOJ’s subpoena for gender-affirming care records against Children's Hospital Colorado in December and opposing subpoenas against Boston Children’s Hospital and Children’s Hospital of Philadelphia in October. In August 2025, he co-led a multistate coalition in filing a lawsuit that challenges the Trump Administration’s executive order that attempts to restrict the provision of medically necessary gender-affirming care for individuals under the age of 19 by threatening providers with civil and criminal prosecution under specious legal theories. 

In filing yesterday’s letters, Attorney General Bonta joined the attorneys general of New York, Connecticut, Illinois, Massachusetts, New Mexico, Washington, Arizona, Colorado, the District of Columbia, Delaware, Maine, Maryland, Michigan, Minnesota, Nevada, New Jersey, Oregon, Rhode Island, Vermont, and Wisconsin.