A Biden-appointed federal judge has ruled American taxpayers must continue spending millions of dollars on transgender procedures in blue states.
A coalition of 20 states, Washington D.C., and Pennsylvania Governor Josh Shapiro, sued Department of Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr. over a December 2025 declaration that told medical providers and organizations they can be denied Medicaid and Medicare funding if they continue providing harmful “sex-rejecting procedures” to children.
“Sex-rejecting procedures for children and adolescents are neither safe nor effective as a treatment modality for gender dysphoria, gender incongruence, or other related disorders in minors, and therefore, fail to meet professional[ly] recognized standards of health care,” states Kennedy’s declaration.
Kennedy clarified in the document that the term “sex-rejecting procedures” includes puberty blockers, cross-sex hormones, and surgeries, which are sometimes referred to as “gender-affirming care.”
U.S. District Judge Mustafa Kasubhai, who is known for his judicial transgender activism, vacated the declaration on April 18, calling it “unlawful” and “one man’s musings on gender-affirming care.”
“This Court is not persuaded by Defendants’ attempts to gaslight it into believing that the Kennedy Declaration does anything other than what it says: proclaims that gender-affirming care for minors falls below professionally recognized standards of care, supersedes state laws that say otherwise,” wrote Kasubhai in his opinion. “Secretary Kennedy’s unlawful declaration harmed children. This case illustrates that when a leader acts without authority and in the absence of the rule of law, he acts with cruelty.”
“HHS will continue to fight to protect our nation’s children, as this Biden-appointed judge’s ruling puts radical ideology ahead of their safety,” HHS Press Secretary Emily Hilliard told The Daily Wire.
The lawsuit’s plaintiffs include: Oregon, Washington State, New York, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, Rhode Island, Vermont, Wisconsin, the District of Columbia, and the Governor of Pennsylvania, Josh Shapiro.
Washington State admitted to spending more than $31 million providing “gender-affirming” services to 10,000+ “transgender” individuals over three years in a legal document submitted in the lawsuit. The federal government financed the bulk of the state’s spending, providing $25 million of the $31 million Washington State spent on transgender procedures from 2022 to 2024. It also spent more than $2 million on transgender interventions for minors just in 12 months, according to the document.
The data was provided in a declaration submitted by Dr. Judy Zerzan-Thul, Washington State Health Care Authority’s Chief Medical Officer.
Washington State has nearly 6,000 “distinct Medicaid providers” offering sex-rejecting interventions, and not allowing providers who accept Medicaid and Medicare payments to “provide gender-affirming care” would cripple the industry, according to Zerzan-Thul.
“The consequence will be that no provider who accepts these forms of payment will be able to provide gender-affirming care to any child or adolescent patient,” states her declaration. “This action will make it very difficult, if not impossible, for Apple Health to find health care providers willing to provide gender-affirming care to Apple Health clients, even if such services were entirely state-funded.”
Apple Health, the umbrella term for the state’s health insurance programs, spent $10.8 million providing sex-rejecting procedures to more than 10,000 “transgender individuals” in 2024, more than $10.6 million providing the procedures to 9,500+ individuals in 2023, and more than $10.1 million providing the procedures to 8,500+ individuals in 2022, according to the Zerzan-Thul declaration.
The Daily Wire previously reported that the Washington State Health Care Authority spent more than $4.3 million on a cosmetic surgery practice led by Dr. Geoffrey Stiller, MD, who offers an array of “transgender” surgical procedures, including facial feminization, “non-binary” double mastectomy, and “bottom surgery,” according to the Stiller Aesthetic website.
Zerzan-Thul cited discredited gender medical guidance from the American Academy of Pediatrics (AAP), Endocrine Society, and the World Professional Association for Transgender Health (WPATH) as the state’s basis for determining that sex-rejecting interventions were “evidence-based, safe, and effective, medical treatments.”
“WPATH remains a globally recognized authority on gender-affirming care, and its Standards of Care have been widely adopted by medical institutions worldwide,” states the Zerzan-Thul declaration.
In its review of pediatric gender medicine, HHS noted that medical gender guidance from the Endocrine Society, WPATH, and the AAP has been found to be of “very low quality.”
The Washington State Health Care Authority did not respond to The Daily Wire’s requests for comment.
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