California Attorney General Rob Bonta (D) is suing a hospital for ending its youth gender-affirming care program using a strategy that legal experts say could be a game changer for efforts to ensure trans minors maintain access to the care they need.

As Erin in the Morning reports, Bonta filed the lawsuit against Rady Children’s Hospital on Friday, just 10 days after the San Diego hospital announced that it would close its Center for Gender-Affirming Care and, beginning February 6, no longer provide medically necessary gender-affirming care to patients under the age of 19.

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According to the East Bay Times, in a statement following its January 20 announcement, Rady cited pressure from the Trump administration, which has threatened to block research and educational grants as well as Medicaid and Medicare reimbursement to institutions that provide gender-affirming care to minors.

“Taken together, these developments affect our role and responsibilities as a provider participating in federal programs such as Medicaid and Medicare, which are essential to caring for children and families in our communities,” the statement read.

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Critics say Rady’s move was premature, as at least two of the rules aimed at cutting funding to hospitals that provide gender-affirming care to minors remain proposals, the East Bay Times reported. And there is no federal law banning gender-affirming care for minors, which is legal in California.

But as Erin in the Morning notes, Bonta’s strategy does not rely on state or federal civil rights law. Rather, in his complaint, Bonta argues that Rady has violated the legally binding conditions it agreed to when he approved its merger with the Children’s Hospital of Orange County in 2024.

In a January 30 press release announcing the lawsuit, Bonta’s office explained that the conditions the California AG placed on the merger “included a requirement that Rady maintain existing levels of specialty healthcare services — including gender-affirming care — through 2034.” They also required the hospital “to obtain approval from the Attorney General before it reduced or eliminated gender-affirming care.”

“Rady Children’s Health has chosen to violate its merger agreement and California law in response to the Trump administration’s illegal campaign against providers of gender-affirming care,” Bonta said in a January 30 statement. “Rady flagrantly disregarded its legal obligations by unilaterally deciding to preemptively comply with the administration’s demands and cease medically necessary care for roughly 1,450 patients. We will not allow Rady to violate its obligations to its patients and the State. We will fight to uphold the law and ensure Californians can access gender-affirming care without facing unfair roadblocks.”

As attorney and trans advocate Rachel See told Erin in the Morning, Bonta’s decision to focus his lawsuit exclusively around Rady’s alleged breach of the merger’s conditions is strategic, allowing him to avoid questions about federal nondiscrimination or constitutional claims, and remain in state court.

“It doesn’t matter why Rady chose to preemptively comply with demands it expects to receive from the federal government. According to the AG, the only thing that matters is that they violated the merger conditions,” See explained. “There’s no federal question and no easy way for the Trump administration’s Department of Justice to interfere.”

While See noted that this particular lawsuit could only have been brought “under California law, because of the California AG’s unique power to approve mergers between California nonprofit hospitals,” Bonta’s strategy could nonetheless provide attorneys general in other states in their efforts to combat the administration’s attacks on gender-affirming care for minors.  

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