Health and Human Services Secretary Robert F. Kennedy Jr. has launched an investigation into Seattle Children’s Hospital for providing gender-affirming careto youth. 

The department announced Friday that it has referred the hospital to the Office of Inspector General for “for failure to meet professional recognized standards of health care as according to Secretary Kennedy’s declaration.” If the department concludes the hospital violated the policy, it could lose its Medicaid and Medicare funding.

Cited in the referral is the agency’s announcement from earlier this month that it is proposing to ban the lifesaving care for those under age 18, and to prevent both Medicaid and the Children’s Health Insurance Program from covering the treatment.

While the HHS does not have the legal authority to implement either policy, a bill criminalizing gender-affirming care for trans youth and another bill banning Medicaid from covering the care were approved by the U.S. House of Representatives also in December. Both bills now head to the Senate, where it is unclear if they have the support needed to pass.

The American Medical Association, the American Psychiatric Association, the American Academy of Pediatrics, the American Academy of Child & Adolescent Psychiatry, the World Medical Association, and the World Health Organization all agree that gender-affirming care is evidence-based and medically necessary not just for adults but minors as well.

Democratic state attorneys general from 18 states and the District of Columbia filed a joint lawsuit challenging the HHS declaration last week, asserting the order “exceeds the Secretary’s authority and violates the Administrative Procedure Act and the Medicare and Medicaid statutes.”

“The Kennedy Declaration is procedurally defective. At minimum, Secretary Kennedy and HHS cannot circumvent statutorily mandated notice and comment requirements by changing substantive legal standards by executive fiat. Congress has not given the Secretary the authority to define the professionally established standard of care,” the suit states, adding that “Congress expressly prohibits ‘any Federal officer … to exercise any supervision or control over the practice of medicine.’”

Washington currently has a “shield” law protecting access to gender-affirming care for youth. HB1469, passed in 2023, prevents health care providers licensed in the state from being prosecuted by other states where the care is criminalized, including protecting them from having to provide documents or patient information even upon subpoena.

Seattle Children’s Hospital has already successfully blocked a subpoena from the Justice Department seeking patient information. It also filed a lawsuit against Texas Attorney General Ken Paxton in 2023 after his office served the hospital with a demand for the information related to the number of Texas minors treated, their diagnoses, the medications prescribed, and advice on how to wean a patient off the treatment.