Federal Policy Update

Executive Orders

EO 14168 – Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government (1/20/25)

• The federal government will only recognize two sexes, male and female.
• Agencies must interpret laws governing sex-based rights accordingly.
• The Secretaries of State and of Homeland Security must ensure that government issued documents reflect the holder’s sex.
• Federal agencies must end federal funding for “gender ideology.”
• Agencies must rescind any previously issued guidance documents that are inconsistent with this order—including a notice of interpretation considering Bostockthat expands the definition of sex under Title IX to include “gender identity.”
• Bureau of Prisons must revise policies allowing federal inmates to receive “gender-affirming care” while incarcerated. Attorney General must ensure that men are not housed in women’s prisons.

EO 14183 – Prioritizing Military Excellence and Readiness (1/27/25)

• Having a diagnosis of gender dysphoria or even a transgender identity is inconsistent with the standards expected of service members.
• Use pronouns and facilities consistent with EO on defining sex.

Current Status: Active. Although litigation is ongoing and there are several active cases (Nicolas Talbott, et al. v. Donald Trump, et al., Ireland v. United States & Shilling v. Trump), the EO is in effect after the Supreme Court issued a stay after the 9th Circuit temporarily blocked enforcement. On 12/9/25, a D.C. District panel issued an order dissolving the earlier stay issued by the 9th circuit.

EO 14187 – Protecting Children from Chemical and Surgical Mutilation (1/28/25)

• The government may not fund, sponsor, promote, or assist with medical transition procedures for youth under 19.
• Federal agencies shall remove any guidance reliant on WPATH.
• HHS shall publish a report on evidence and best practices within 90 days of the EO and use the means at its disposal to acquire more high-quality data on minor patients who seek transition procedures.
• Heads of agencies shall take steps to ensure that institutions receiving federal research or education grants end their support for GAC.
• Rescinds Biden-era guidance on GAC and calls on the Secretary of Defense to engage in rulemaking to end TRICARE’s coverage of medical transition for the children of enlisted servicemembers.
• DOJ/AG shall investigate “female genital mutilation” and consumer fraud related to GAC.

Current Status: Partially Active. Litigation is ongoing in several cases (PFLAG v. Trump, State of Washington v. Trump, Massachusetts v. Trump, & Doe v. Department of Defense). InPFLAG v. Trump, a judge issued a nationwide injunction blocking enforcement of the funding provisions of EO 14187, which aimed to prohibit federal funds for GAC for persons under 19. In Washington v. Trump, a judge also issued a PI blocking enforcement in the states of Washington, Minnesota, Oregon and Colorado as litigation plays out. In early November, a District Judge Lauren King denied a second motion to stay the injunction issued in Washington v. Trump.

EO 14190 – Ending Radical Indoctrination in K-12 Schooling (1/29/25)

• Aims to eliminate federal funding and support for programs that advance gender ideology.
• Takes aim at the practice of social transition in schools.

Current Status: Active

EO 14201: Keeping Men Out of Women’s Sports (2/5/25)

• Conditions the receipt of federal funds for education programs on promoting “fair athletic opportunities” for women and girls.
• The order also calls on the domestic policy advisors to work with athletic organizations to ensure that their policies are consistent with the EO.

Current Status: Active, despite ongoing litigation (Tirrell v. Edelblut & California v. Department of Justice).

U.S Department of Health and Human Services (HHS)

2/19/20: The Office of the Assistant Secretary of Health releases sex-based definitions to guide the enforcement of EO 14168.

2/20/25: HHS rescinded previous guidance on GAC, civil rights, and patient privacy

• Previous guidance (“HHS Notice and Guidance on Gender Affirming Care, Civil Rights, and Patient Privacy”): providers who refuse to render GAC may violate Section 1557 of the ACA; health care providers and other “covered entities” may not release private health information relating to GAC without patient clearance; GAC may qualify as a disability under the ADA, despite being excluded in the language of the ADA itself.

3/5/25: Quality and Safety Special Alert Memo

• The memo signals that CMS will begin taking steps to adjust its policies on GAC to better align with evidence-based standards.

4/11/25: CMS Issues Letter to Medicaid Directors

• CMS issued a letter to Medicaid directors highlighting the weak evidence and suggesting that GAC may violate provisions of the Social Security Act. In May of 2025, CMS admin, Dr. Mehmet Oz, issued a letter to select hospitals requesting information about adherence to quality control standards, and financial information, pertaining to GAC.

5/1/25: HHS Releases Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices

6/5/25: Rescission of 2023 Guidance on Adding SOGI Questions to State Medicaid and CHIP Applications for Health Coverage

6/25/25: Final Rule on Marketplace Integrity and Affordability

• The rule prohibits health insurers from considering “sex-trait modification procedures” as an essential health benefit (EHB) under the Affordable Care Act, which would apply to plan year 2026 if allowed to go into effect. (21 states have challenged the rule, but no injunction has been issued.)

8/26/25: Administration for Children and Families (ACF) Issues Notice on PREP Grants

• HHS issued letters to 46 states and 6 territories demanding that all references to “gender ideology” be removed from federally funded Personal Responsibility Education Program (PREP) educational materials (for kids who are homeless or in foster care) as a condition for federal funds. After California refused to comply after a similar warning, ACF terminated the state’s PREP grant. On 10/27/25, a federal judge in Oregon issued a preliminary injunction blocking the decree that “gender ideology” must be removed from all sexual health education curricula. The lawsuit was filed on behalf of sixteen states.

9/30/25: ACF Issues Letter to the Massachusetts DCF Addressing Foster Policy

• ACF sent a letter to the Massachusetts Department of Child and Families vowing to investigate its “LGBTQIA+ Non-discrimination Policy” which requires foster parents to agree to affirm a child’s “gender identity” as a condition for maintaining their foster license.

10/22/25

• Federal court in Mississippi vacates Biden HHS rule (2024) that codifies sex = gender identity in Section 1557. Rejects Bostock reasoning, adds that even if Bostock reasoning applied, it wouldn’t apply to medical issues (resolved in Skrmetti). Interpreting 1557 to include sex must be done by Congress.

10/30/25

• NPR reported on two proposed rules yet to be formally announced. One rule would prohibit Medicaid and CHIP reimbursement for GAC while the other would block Medicare and Medicaid funding from going to health care entities that render GAC.

11/19/25 

• HHS released a peer-reviewed version of its report on best practices and evidence for the treatment of pediatric gender dysphoria.

12/9/25

• HHS announced an investigation into an unnamed state health department to determine if the department’s practices violated federal religious and conscience protections by requiring organizations and physicians to “facilitat[e] sex-rejecting procedures and female genital mutilation (FGM).”

12/18/25

• HHS formally announced two anticipated proposed rules with implications for hospitals that render “sex-rejecting procedures” on dysphoric minors. One rule would prohibit Medicaid and CHIP reimbursement for GAC, while the other rule would block Medicare and Medicaid funding from going to health care entities that render GAC.
• HHS announced a proposed rule which would modify a Biden-era rule to explicitly state that statutory exclusions for “gender identity disorder not resultant from physical impairments” include gender dysphoria.
• HHS Assistant Secretary, Admiral Brian Christine, issued a public message onEvidence-Based Care for Children and Adolescents with Gender Dysphoria that aims to educate the public about the low-quality evidence for benefits, and unfavorable risk-benefit profile of, GAC. The message advises health care providers not to render these practices, and to prioritize developmentally informed psychotherapy and counseling that targets the comorbidities often associated with gender dysphoria.
• Health Secretary Kennedy issued a declaration formally asserting that “Sex-rejecting procedures” for pediatric gender dysphoria are inconsistent with professional health care standards.

12/23/25

• In response to Health Secretary Kennedy’s declaration on sex-rejecting procedures, nineteen states plus D.C. have filed a legal challenge arguing that the declaration exceeds Kennedy’s authority and violates the Administrative Procedure Act and Medicare and Medicaid statutes.

12/30/25

• HHS General Counsel Mike Stuart announced probes into several hospitals for rendering sex-rejecting procedures, however, as part of the lawsuit challenging HHS’ declaration on sex-rejecting procedures, the agency has agreed to temporarily hold off on punitive measures and allowed the hospitals to continue to participate in federal health care programs.

1/9/26

• HHS General Counsel Mike Stuart announced investigations into three California hospitals: Children’s Hospital of Orange County, UCSF Hyde Hospital and Benioff Children’s Hospitals.

1/15/26

• HHS General Counsel Mike Stuart announced new investigations into six hospitals—including Boston Children’s Hospital and Lurie Children’s Hospital of Chicago—for continuing to render “sex-rejecting procedures.”

U.S. Department of Justice

2/7/25: Letter to the Supreme Court

• The letter notified the Court that “the government’s previously stated views” on U.S. v. Skrmetti “no longer represents the United States’ position.”

4/22/25: AG Pam Bondi Issues Memo Preventing the Mutilation of American Children

• Bondi’s memo builds on the groundwork laid in EO 14187 (“child mutilation”). Outlines several key priorities including: 1) investigating cases of GAC that culminate in “female genital mutilation” of anyone under 18; 2) investigating cases in which medical providers and pharmaceutical companies may have violated the FDA Act and False Claims Act; 3) removing all guidance, materials and court filings that rely on WPATH SOC-8; 4) collaboration with state AGs for information-sharing; 5) outlining a proposal for national legislation that bans GAC for minors.

6/1/25: FBI Calls for Tips on Practitioners and Hospitals Rendering GAC

• The FBI made a request on social media for the public to report tips about possible violations of the government’s directives on GAC.

6/11/25: Brett Shumate Letter to DOJ’s Civil Division Employees

• Assistant AG Brett Shumate sent a letter to all Civil Division employees of the DOJoutlining enforcement priorities. The memo reiterates the Division’s priorities outlined in the Bondi memo (April) and asserts that the division will use its resources to prioritize investigations related to violations of the FDA Act and False Claims Act (e.g., submitting claims to Medicaid with false diagnostic codes to evade state bans on GAC <18).

7/9/25: Investigations into Doctors and Clinics Rendering GAC

• DOJ released a press release announcing that over twenty subpoenas had been sent to physicians, clinics and hospitals, including CHOP and BCH, as part of investigations into healthcare fraud.
• After BCH challenged the subpoena, a federal judge ruled in its favor, arguing that the subpoena was “too broad” and that the administration showed clear signs of animus. The injunction is currently being challenged.

Summer, 2025: Establishment of Enforcement and Affirmative Litigation Division

• Focused on gender medicine action (e.g., subpoenas).

12/4/25: DOJ Memo instructs Prison Auditors to Deviate from PREA LGBTQ Safeguards

• NPR reported that while the DOJ works to revise federal standards related to the 2003 Prison Rape Elimination Act (PREA), a memo has advised prison staff conducting PREA audits not to follow protocol for maintaining LGBTQ safeguards.

U.S. Department of Education

2/4/25: Dear Colleague Letter

• OCR issued a Dear Colleague Letter making it explicit that educational institutions are expected to follow the principles and provisions of the 2020 (Trump I) Title IX rule, which does not redefine sex to include “gender identity.”
• The Department simultaneously halted implementation of the 2024 Title IX regulations—which were also blocked nationwide by a U.S. District Court Judge—issued under the previous administration.
• The administration has also published an overview of its Title IX policies.
• OCR has conducted investigations in response to alleged Title IX violations and made determinations of non-compliance in cases involving the University of Pennsylvania, the California Dept. of Education (CDE) & California Interscholastic Federation (CIF), the Maine Department of Education, the Minnesota Department of Education, five Northern Virginia school districts, and Denver Public Schools, among others. As part of deals with the admin, the University of Pennsylvania,Columbia, Cornell, Brown and Northwestern have entered into resolution agreements with DOE vowing to uphold Title IX.

8/7/25: DOE Issues Notice of Revision to Civil Rights Data Collection policy

• DOE proposed a revision which would culminate in ending data collection on transgender identities, to comply with EO 14168.

1/14/26

• The DOE announced “investigations into eighteen educational entities in ten states” based on submitted complaints that allege the entities discriminate based on sex by permitting students to participate in sports based on their “gender identity.”

U.S. State Department

11/21/25: State Department Labels Pediatric Medical Transition a Human Rights Violation

• In anticipated new guidance, the State Department plans to issue new rules to US embassies and consulates outlining human rights violations for the purpose of record keeping, including labeling pediatric medical transition a human rights abuse.

1/23/26: State Department Expands “Mexico City” Abortion Policy to DEI and Gender Ideology

• The State Department is set to expand its Mexico City Policy—which prohibits recipients of foreign aid from promoting abortion—to DEI and Gender Ideology, with implications for both foreign and U.S. NGOs and $30 billion in foreign aid.

Federal Trade Commission

7/9/25: FTC Holds Workshop on Deceptive Trade Practices

• FTC held workshop on unfair or deceptive trade practices related to GAC, subject to the agency’s Section 5 powers.

7/28/25: FTC Requests “Public Comment” on GAC

• FTC announced a request for information to “better understand how consumers may have been exposed to false or unsupported claims about ‘gender-affirming care,’ especially as it relates to minors, and to gauge the harms consumers may be experiencing.” The comment period extended until September 26th, 2025.