On Friday, the Department of Justice announced it had reached a settlement with the New York City-area hospital network Mount Sinai—one of the largest providers in New York State—over allegations of ‘fraudulent billing practices’ surrounding gender-affirming care for minors. Under the terms of the binding agreement, Mount Sinai has agreed to permanently “cease providing these interventions to minors, including by administering puberty blockers and cross-sex hormones and performing surgical procedures,” even after Trump’s term ends, as well as pay a ‘monetary penalty’ and “dedicate $2 million to providing free medical care to individuals suffering harmful consequences of ‘gender affirming care’ they received as children.” According to LawDork’s Chris Geidner, the organization settled so it wouldn’t have to hand over trans kids’ medical records, which the Trump administration is seeking from providers nationwide.
This isn’t the first time this has happened, either. In May, the Texas Children’s Hospital (TCH), the largest children’s hospital in the state, struck an even harsher agreement, permanently cutting gender-affirming care, paying a $10 million fine, and creating a detransition clinic that will offer free care for the next 5 years. Perhaps more concerningly, under the settlement, TCH must also maintain two lists of patients: one for those who have a gender dysphoria-related diagnosis code appearing anywhere in their medical records and a “Potential GAC Patient List” for patients with past or present diagnoses—from any provider, not just TCH—of precocious puberty (E30.0, E30.1, E30.8), intersex conditions (E25.9, E34.51, Q56.4), hormonal imbalances and disorders (E22.8, E22.9, E23.6, E23.7, E27.49, E29.1, Z86.39), and constitutional tall stature (E34.4), as well as those who have experienced painful menstrual cramps (N94.6, N94.89) or who have been prescribed birth control pills at any point in their lives (Z30.011).
The next month, the Cleveland Clinic—yes, the Cleveland Clinic—announced it agreed not to provide gender-affirming care for minors for the next 20 years at any of its locations across Ohio, Florida, Nevada, Canada, and the UK. The settlement also required that Cleveland Clinic put $2 million towards providing free detransition care, which the clinic has already begun offering at its locations in Ohio and Florida. And in August, Connecticut Children’s Hospital (CCH) settled its case as well, agreeing to never again offer care for trans youth, pay an undisclosed monetary penalty, and “dedicate an additional $500,000” to providing free detransition care. The full details of the CCH and Mount Sinai agreements have not been made public, although it should be noted that Connecticut Democrats have recently announced that they are working on forcing CCH to provide any documents surrounding its deal.
Especially in blue states, these agreements threaten to put permanent barriers on trans kids’ care access. As was mentioned above, the commitments CCH and Mount Sinai have made are permanent, and once Trump leaves office, these hospitals will remain legally bound to follow through. Because of that fact, the care network for trans youth in those states will continue to be strained even after the federal threats finally cease. After all, when a hospital like Mount Sinai is suddenly removed from that network, the trans kids who rely on it don’t just disappear; they still have to seek care somewhere else, and with one less major provider available, that will become more difficult. That said, this issue is more pronounced in Connecticut, as prior to 2025, CCH was only one of two known care providers for trans youth in the state. The other provider, Yale, has paused that care as well but hasn’t signed an agreement that would make that cessation permanent.
And we’ve already seen what can happen when major providers are suddenly forced to cut gender-affirming care. As Transitics reported in July, Oklahoma abruptly banned 30% of its doctors from providing gender-affirming care to all ages, and the result has been catastrophic. Even now, clinics like Planned Parenthood are still unable to keep up with the demand, with trans Oklahomans in Oklahoma City and Tulsa being forced to wait upwards of 1 month for appointments that are often available same-day in most other states. Worse, because Planned Parenthood groups 5 states into its “Greater Plains” network—Arkansas, Kansas, Louisiana, Missouri, and Oklahoma—and shares telehealth appointments between them, those appointments continue to be entirely unavailable throughout these states.
Nonetheless, the most sinister parts of these settlements lie elsewhere. First, there’s the motivation behind them: as Transitics reported in May, Trump’s DOJ has been increasingly aggressive in its attempts to force care providers to turn over trans kids’ medical information, including their names, addresses, and social security numbers. In theory, most of that information—especially if Medicaid or CHIP are involved—could be found through billing codes and insurance claim information. However, as the Trump administration has repeatedly complained about, this isn’t a catch-all solution in practice due to the fact that many providers have avoided using trans-specific diagnosis codes in order to protect their patients.
Indeed, this is exactly what the DOJ is investigating these hospitals over: ‘billing fraud.’ Why? Because that extra layer of privacy has prevented them from being able to compile the list of trans kids that they’ve been wanting to make. The resulting fraud investigations appear to function as a punishment for the existence of these roadblocks and will undoubtedly serve to dissuade providers from taking similar actions in the future. Put differently, it can be said that the Trump administration is angry over the fact that it cannot make a list of trans kids easily and, through these investigations, it’s seeking to go after the organizations it deems responsible.
The second and greater concern surrounds the ideas that these settlements and detransition clinics convey to trans kids. For decades, conservatives have vehemently argued against ‘taxpayer-funded transgender surgeries,’ and in recent years, many red states have enacted laws and policies doing just that: banning the use of public funds for trans people’s medically necessary healthcare. In their view, trans people shouldn’t get treatment for free because being trans is inherently a ‘choice’—and they shouldn’t ‘encourage’ that choice. But now, the Trump administration is mobilizing the entire federal investigative apparatus and the massive amounts of taxpayer funding it relies on specifically to pressure clinics into offering free detransitions. These actions do nothing but endorse the idea that trans people should detransition.
Even worse, there’s another component to this implication. Through these investigations and other actions, Trump is making gender-affirming care much more difficult for trans kids to access. On the other hand, thanks to these settlements, detransition care is easier to access than it ever has been. For families of trans kids who find themselves unable to pay the travel or out-of-pocket costs that are now necessary to get this care, there are really only two choices: 1) continue to seek care in another state and potentially spend money they don’t have to do so or 2) accept a free, state-sponsored detransition—which includes ‘hormone balancing’ services per the settlements—and resume their transition when they turn 18. Unfortunately, it is essentially a statistical guarantee that a non-zero number of trans kids will be forced to go with the second option, especially if they live in Ohio or Texas.
At least in Connecticut and New York, these settlements appear to violate gender identity nondiscrimination laws. In both cases, the hospitals will continue to provide detransition care to kids and adults alike—including hormone therapy and potentially even surgeries—to those seeking to detransition while refusing to provide those exact same treatments to trans kids. Be that as it may, because both states have already allowed these providers and many others to cut care for trans youth despite their repeated assertions that doing so violates state law, it remains to be seen whether these protections will finally be enforced. However, the fact that the full terms of the CCH and Mount Sinai agreements have remained private—while the TCH and Cleveland Clinic settlements haven’t—does suggest that the terms of those agreements may make CCH and Mount Sinai much more vulnerable to lawsuits than they have so far let on.
But regardless of the outcome, one fact is clear: the Trump administration is now actively trying to push trans kids into detransitioning. Even in blue states, some providers are taking the deal, permanently shuttering their youth gender-affirming care programs and offering free detransitions in their stead. And if these settlements continue to expand to other providers, accepting a free detransition may very well become the only choice some trans kids have left.
Thank you for sharing the news of this shit. I can't handle hearing it, but I need to know it.
This will kill children. And that pedophile doesn't care