A coalition of 19 states and the District of Columbia filed a lawsuit Tuesday against the U.S. Department of Health and Human Services, its secretary Robert F. Kennedy Jr., and the department’s inspector general, challenging a recent declaration that could restrict access to gender-affirming care for children and adolescents.

The declaration, issued last Thursday, asserts that treatments such as puberty blockers, hormone therapy, and gender-affirming surgeries are unsafe and ineffective for young people experiencing gender dysphoria — the distress that can occur when a person’s gender identity does not align with their sex assigned at birth. It also warns health care providers that offering such care could jeopardize their participation in federal programs, including Medicare and Medicaid.

The lawsuit was filed in U.S. District Court in Eugene, Oregon, and seeks to block enforcement of the declaration, arguing it is both inaccurate and unlawful. The complaint does not address additional proposed HHS rules announced alongside the declaration because those measures are not yet final.

The legal challenge marks the latest confrontation between an administration that has moved to restrict gender-affirming care for minors — citing concerns about potential harm — and advocates and medical professionals who argue the care is evidence-based, medically necessary, and should remain available.

“Secretary Kennedy cannot unilaterally change medical standards by posting a document online,” New York Attorney General Letitia James, who is leading the lawsuit, said in a statement. “No one should lose access to medically necessary health care because the federal government interfered in decisions that belong in doctors’ offices.”

The lawsuit alleges that HHS used the declaration to pressure providers into halting gender-affirming care while bypassing legally required procedures for changing federal health policy. It argues that federal law mandates public notice and an opportunity for comment before substantive policy shifts — steps the states say were not taken.

An HHS spokesperson declined to comment on the lawsuit.

HHS said the declaration was informed by a peer-reviewed report conducted earlier this year that recommended greater reliance on behavioral therapy for youth with gender dysphoria and raised concerns about existing treatment standards, including those issued by the World Professional Association for Transgender Health. The report also questioned whether adolescents are capable of consenting to treatments that could result in permanent changes, including infertility.

Major medical organizations and providers who treat transgender youth have criticized the report as flawed and misleading. Most leading U.S. medical groups, including the American Medical Association, continue to oppose restrictions on gender-affirming care for minors.

The declaration is part of a broader effort by the Trump administration to limit access to gender-affirming health care for children and teenagers nationwide. On Thursday, HHS also proposed two federal rules — one that would bar hospitals providing such care to minors from receiving Medicare and Medicaid funding, and another that would prohibit federal Medicaid dollars from being used for gender-affirming procedures for children.

While the proposed rules are not yet legally binding and must undergo a formal rulemaking and public comment process, advocates say their announcement has already had a chilling effect. Several major health care providers have reduced or suspended gender-affirming services for young patients, including in states where the care remains legal.

Currently, Medicaid programs in fewer than half of U.S. states cover gender-affirming care. At least 27 states have enacted laws restricting or banning such treatment for minors. A recent Supreme Court decision upholding Tennessee’s ban is expected to allow similar laws in other states to remain in effect.

The lawsuit was joined by Democratic attorneys general from California, Colorado, Connecticut, Delaware, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, New Jersey, New Mexico, Oregon, Rhode Island, Vermont, Wisconsin, Washington, and the District of Columbia. Pennsylvania Governor Josh Shapiro also joined the legal challenge.