The department says the rule applies an exclusion Congress wrote into law in 1990 and 1992, while disability and LGBTQ legal groups say they expect a court challenge.
The Department of Health and Human Services has finalized a rule stating that gender dysphoria not resulting from a physical impairment is not a disability under Section 504 of the Rehabilitation Act. The 1973 law bars disability discrimination in federally funded programs, and the rule applies to every program and activity that receives HHS money, including California hospitals, clinics and county health systems.
The department announced the rule on Oct. 30, when it went on public inspection at the Federal Register. It is scheduled for formal publication on Tuesday and takes effect 60 days later.
The department’s case
HHS presents the rule as a matter of statutory text. When Congress passed the Americans with Disabilities Act in 1990, and when it aligned the Rehabilitation Act in 1992, it excluded several conditions from the definition of disability. Among them were “transvestism, transsexualism” and “gender identity disorders not resulting from physical impairments.” The new regulation, at 45 C.F.R. 84.4(g), writes those exclusions into HHS’s rules. It adds that the phrase “includes gender dysphoria not resulting from physical impairments.”
The final rule rests on what the words meant when Congress wrote them. The statute does not define “gender identity disorders,” so HHS says the term “must be given the ‘ordinary meaning’ it had at the time of its adoption.” It relied on the 1987 revised third edition of the American Psychiatric Association’s diagnostic manual, the edition in force in 1990 and 1992. Later editions, which in 2013 introduced the diagnosis of gender dysphoria, “may be relevant,” the department wrote, but “evolving medical classifications of gender disorders cannot change the meaning of the statutory language.”
HHS also says it is resolving confusion of its own making. The preamble to a 2024 rule under the Biden administration said gender dysphoria did not fall within the statutory exclusion, though the regulation itself was silent. In April 2025, the department said in a Federal Register notice that the preamble “does not have the force or effect of law.” The new rule, it says, is needed “to resolve ambiguity” and to comply with “the best reading of the governing statute.”
“Congress defined which conditions qualify for protection as disabilities under federal law, and HHS has a duty to faithfully apply the law as written,” Health and Human Services Secretary Robert F. Kennedy Jr. said in a statement. He said the rule “restores clarity to our regulations” and “respects the distinctions Congress established.”
Paula M. Stannard, director of the HHS Office for Civil Rights, said the rule “ensures recipients of HHS funding follow those definitions, eliminating confusion for the people they serve.”
The department received more than 380 comments, and the final text is unchanged from the December 2025 proposal. Responding to commenters, HHS wrote that the rule “is not based on an effort to harm a population for political gain.” It said the rule makes no judgment on whether gender dysphoria is “legitimate.” People with gender dysphoria, it said, remain covered by federal laws barring discrimination based on race, national origin, sex and age, and by Section 504 for any other disability they have.
The critics’ case
“HHS describes this rule as a clarification. It is not. It takes civil rights protections away from transgender people,” said Michelle Uzeta, executive director of the Berkeley-based Disability Rights Education and Defense Fund. “The rule applies to every hospital, clinic, health plan, child welfare agency, and human services program that receives HHS funding. It tells all of them that people with gender dysphoria are not protected under Section 504.”
Ms. Uzeta said that “people with gender dysphoria could be denied medical care, including care that has nothing to do with gender dysphoria, such as treatment for a broken arm or diabetes.” HHS’s preamble says people with gender dysphoria remain protected under Section 504 for other disabilities.
“Yes, we expect this rule to be challenged, and there are strong grounds to do it,” she said. “First, an agency can’t rewrite a statute, and courts no longer defer to agencies on what a statute means.” HHS cites the same 2024 Supreme Court decision ending that deference, Loper Bright, for its view that the statute’s best reading controls.
The sharpest legal conflict is with Williams v. Kincaid, a 2022 decision by the U.S. Court of Appeals for the Fourth Circuit. That court held that gender dysphoria falls outside the statutory exclusion, and the Supreme Court declined to review the case in 2023. HHS acknowledges that Williams is “binding precedent within federal courts in Maryland, North Carolina, South Carolina, Virginia, and West Virginia,” but says it “diverges with the rulings of numerous other courts.”
What it means in California
“The HHS rule applies only to HHS, not even to other federal agencies, and it has no effect whatsoever on California’s own laws,” said Shannon Minter, legal director of the San Francisco-based National Center for Lesbian Rights.
He cited the Fair Employment and Housing Act, the Unruh Civil Rights Act, Government Code section 11135 and the Insurance Gender Nondiscrimination Act. “In addition, California’s definition of disability includes gender dysphoria, so a Californian who is denied care or treated differently because of that diagnosis has a claim under state disability law regardless of what HHS says about federal law,” Mr. Minter said. “The rule is unlawful because it contradicts the statute and has no justification. We are evaluating a challenge.”
HHS addressed state law in the rule. “Where there is a direct conflict, section 504 and similar Federal nondiscrimination laws will usually preempt conflicting state laws,” it wrote. But “States may impose their own laws, provided the State law does not serve as an obstacle to or frustrate the purpose of Federal law.”
The HHS press office and Lambda Legal did not respond to requests for comment. Equality California sent an automated acknowledgment but had not commented by publication time.
Adaeze Monroe covers Congress, the White House and federal agencies, with a focus on what Washington’s decisions mean for California, for the Washington Bureau. More from Adaeze Monroe
