Hospitals' trans care pause draws backlash, legal threats

• More families of transgender and gender-diverse kids are moving to blue states to find better access to care.

The latest: New York Attorney General Letitia James sent a letter to hospitals in her state Monday notifying them that denying care to transgender kids could violate state antidiscrimination laws, the New York Times reported.

• Lambda Legal, a civil rights organization focused on LGBTQ+ rights, promised last week to take quick action against the Trump administration order.
• Protesters over the weekend marched at UVA Health in Charlottesville, Virginia, and at Children's National Hospital in Washington, D.C., two providers that paused services for minors following the executive order.
• Colorado advocates are looking to state laws and policies, including one that covers gender-affirming care as an essential health benefit for people on individual and small group plans, to protect access to care. That came after Denver Health suspended some forms of care last week.

Yes, but: Virginia's Republican Attorney General Jason Miyares sent UVA Health and Virginia Commonwealth University a memo advising them to stop providing care immediately and said his office will be closely monitoring the issue, Axios Richmond's Sabrina Moreno reported.

The big picture: Trump's order threatens a cutoff of Medicare and Medicaid funding to facilities providing gender-affirming care to anyone under age 19.

• It also calls on the Justice Department to review laws against female genital mutilation and attempt to apply them to gender-affirming care providers.
• Gender-affirming care is supported by major medical organizations including the American Medical Association, the American Academy of Pediatrics and the American Psychiatric Association.
• Drugs like puberty blockers are temporary and reversible and used for both trans and non-trans youth who experience early onset puberty. The majority of people who accessed transition-related care as adolescents are happy with that decision as adults, according to a study published in the Journal of Adolescent Health in November.

What they're saying: Denver Health said in a statement that guidance on changes to medical care is being handled privately between clinicians and patients, and behavioral and primary care services won't be affected.

• "The loss of [Medicare and Medicaid] funding would critically impair our ability to provide care for the Denver community," Denver Health said.

Between the lines: The ACLU, for its part, does not interpret the executive order as requiring hospitals to take direct action, said Harper Seldin, a senior staff attorney at the civil liberties group's LGBTQ and HIV Project.

• But hospitals' decision to pause their practices in response "reflects the climate of fear and threats that these executive orders are trying to create," he said.

Reality check: Many hospitals are continuing to offer gender-affirming care services.

• On a call with more than 200 providers over the weekend, the vast majority said they're still seeing patients as usual, said Morissa Ladinsky, a pediatrician who participated in the call.
• "They fully understand that an executive order is not a law, a regulation or a mandatory action," said Ladinsky, who helped establish a gender health team at the University of Alabama Birmingham's health system.

The Children's Hospital Association is still reviewing the order, the organization told Axios.

• "Children's hospitals prioritize the physical and mental health, safety and well-being of children, adolescents, and young adults," the organization said in a statement.
• Medicaid covers on average almost half of patients at children's hospitals, CHA said in 2023.

Go deeper: Trump's road map for defunding gender-affirming care