On March 4, 2025, U.S. District Court Judge Brendan A. Hurson issued a nationwide preliminary injunction restricting the U.S. Department of Health and Human Services (HHS), the Health Resources and Services Administration (HRSA), the National Institutes of Health (NIH), the National Science Foundation (NSF) and any subagencies of HHS from conditioning, withholding, or terminating federal funding under Executive Order 14168 (the “Gender Identity Order”) and Executive Order 14187 (the “Healthcare Order”), because a healthcare entity or health professional provides gender affirming medical care to a patient under the age of nineteen. The preliminary injunction extends the relief granted in a temporary restraining order (TRO) first issued on February 13, 2025, and then extended through March 5, 2025. Unless overturned on appeal, the nationwide protection of existing funding is now in place until the case is resolved.

Background on PFLAG Inc., et al. v. Trump, et al.

The Plaintiffs, which include six transgender minors whose gender affirming medical care was discontinued after Executive Order 14187 was issued and two nationwide nonprofit organizations (PFLAG and GLMA), challenged:

• Section 3(g) of the Gender Identity Order, which provides that “Federal funds shall not be used to promote gender ideology. Each agency shall assess grant conditions and grantee preferences and ensure grant funds do not promote gender ideology.”
• Section 4 of the Healthcare Order, which directs “the head of each executive department or agency (agency) that provides research or education grants to medical institutions, including medical schools and hospitals, [to], consistent with applicable law and in coordination with the Director of the Office of Management and Budget, immediately take appropriate steps to ensure that institutions receiving Federal research or education grants end the chemical and surgical mutilation of children.”

The Plaintiffs’ suit alleges that the Executive Orders:

• Violate the Constitution’s structural guarantee of separation of powers between the three co-equal branches of the federal government, because the President exceeded his executive authority and usurped Congress’ legislative and spending powers;
• Conflict with Section 1557 of the Affordable Care Act (ACA) and Section 1908 of the Public Health Services (PHS) Act, which prohibit discrimination on the basis of sex; and,
• Violate the equal protection guarantee of the Fifth Amendment’s Due Process Clause, because a ban on all gender affirming medical care for those under nineteen by federally funded institutions is not substantially related to an important government interest.

Preliminary Injunction

In granting the preliminary injunction, Judge Hurson found the high bar for such relief was met, concluding:

• The Plaintiffs would likely succeed on the merits of all three of their challenges to the implementation of the EOs;
• The Plaintiffs demonstrated they are likely to suffer irreparable harm without injunctive relief; and
• The balance of equities and the public interest tip in favor of blocking the EOs and preserving the status quo while the case is fully decided.

The court ordered that:

• HHS, HRSA, and the other Defendants are enjoined from conditioning, withholding, or terminating federal funding under Section 3(g) of Executive Order 14168 and Section 4 of Executive Order 14187, based on the fact that a healthcare entity or health professional provides gender-affirming medical care to a patient under the age of nineteen.
• The Defendants must provide a notice of the preliminary injunction to all Defendants and their employees, contractors, and grantees by March 10, 2025. The written notice must instruct Defendant agencies to release any disbursements on grant or other funds that were paused due to the Executive Orders.

What to Watch for Next

• Unless overturned on appeal, the nationwide protection of existing funding is in effect until there is a final decision on the merits of the case.
• By March 10, 2025, contractors and grantees should receive a notice about the preliminary injunction, reiterating the court’s order that the Defendant federal agencies (including HRSA) shall not condition or withhold federal funding based on the healthcare entity’s provision of gender affirming care to patients under the age of nineteen.
• Defendant agencies should release any disbursement of funds that were paused due to the Executive Orders; however, given that NIH recently terminated some research grants on transgender health, it is unclear whether the agencies will comply with the court’s order or provoke further motions and likely enforcement orders in the ongoing case.
• Expect attacks on gender affirming medical care for minors—and adults—to continue, not only from the Executive Branch, but also from Congress. With control of both Congress and the White House, Republicans are likely to introduce bills aimed at restricting gender affirming medical care. Regarding Executive Branch activity, CMS recently issued a Quality & Safety Special Alert Memo (QSSAM-25-02) on gender affirming medical care for minors, noting that it “may begin taking steps in the future to align policy, including CMS-regulated provider requirements and agreements” with the positions outlined in the QSSAM. We expect OASH, HRSA, and OCR are likely to withdraw remaining guidance documents and recommendations related to gender affirming medical care that were issued under previous Administrations.

For more information related to Executive Orders affecting gender affirming care, please contact Feldesman attorneys Molly S. Evans, Rosie Dawn Griffin, and Dianne K. Pledgie.