Office of the
Illinois Attorney General
Kwame Raoul

Chicago – Attorney General Kwame Raoul co-led a coalition of 22 states in challenging the Trump administration’s attempt to prohibit states from using federal Medicaid funds for gender-affirming care for low-income minors and some young adults.

“At a time when our country faces a true healthcare crisis due to spiraling costs of care, a shortage of providers, and rural hospital closures leaving communities with no providers for miles, the Trump administration is attempting to score political points by continuing to threaten healthcare for a very small and vulnerable population,” Raoul said. “No federal agency has the power to directly regulate the practice of medicine—a traditional and congressionally recognized power reserved for the states. If the Trump administration is allowed to decide what is safe and appropriate healthcare for this population, what’s to stop them from meddling in everyone’s care? The administration’s unlawful actions should concern us all, as they affect us all—today or in the future.  I remain firmly committed to advocating for the rights of transgender youth and to protecting all Illinoisans from unlawful federal interference in their healthcare choices.”

In their lawsuit, Raoul and the coalition argue that since the creation of the Medicaid and Children’s Health Insurance Program (CHIP) programs in the 1960s, Congress has always granted states the authority to determine which services would be covered under their Medicaid and CHIP programs, subject only to limits set by statute. The coalition asserts that the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) are now acting without statutory authority or a reasoned basis to second-guess state Medicaid agencies’ reliance on individualized medical necessity and treatment decisions made by healthcare providers. Instead, based solely on CMS’s unilateral decision-making, the agencies are categorically excluding medically necessary healthcare services from federal reimbursement only when provided to low-income transgender adolescents.

In December 2025, HHS proposed a rule prohibiting federal reimbursement for gender-affirming care for Medicaid beneficiaries under age 18 and CHIP beneficiaries under age 19, despite covering the same healthcare treatment when provided to non-transgender youth. HHS received more than 30,000 comments on the proposal. More than 90% of the comments, including comments from a coalition of state attorneys general co-led by Raoul, opposed the rule. Despite this strong opposition, the broad medical consensus on the safety and efficacy of transgender youth healthcare and strong state law guardrails to ensure high-quality care, HHS finalized the rule earlier this month, with an effective date of Oct. 13, 2026.

In their complaint, Raoul and the coalition argue that the rule would set a troubling and unlawful precedent that the executive branch can, without congressional authorization, replace individualized judgments made by licensed medical practitioners with a categorical, agency-determined prohibition on reimbursement for healthcare it disfavors.

The coalition argues that the rule runs counter to several federal and state laws. They also assert that the rule violates the Administrative Procedure Act and the Spending Clause of the U.S. Constitution.

Since the first day of President Trump’s second term, the administration has launched relentless attacks on this small and vulnerable population in nearly every aspect of their lives, but especially in healthcare. Attorney General Raoul has challenged the administration’s actions on all fronts, leading litigation to counter attacks on providers, working to protect vital healthcare funding, supporting professional medical associations when they bring suit and protecting patients whose care and sensitive healthcare information remains at risk.

Raoul co-led the coalition with the attorneys general of California, Connecticut, Maryland and Massachusetts. Joining them in filing today’s lawsuit are the attorneys general of Colorado, Delaware, the District of Columbia, Hawaii, Maine, Michigan, Minnesota, Nevada, New Jersey, New York, Oregon, Rhode Island, Vermont, Virginia, Washington, and Wisconsin, along with the governor of Pennsylvania.