HHS final rule says gender dysphoria is excluded from Section 504 disability protections

The Department of Health and Human Services published a final rule in the Federal Register on Tuesday, November 3, 2026, stating that gender dysphoria that does not result from a physical impairment is excluded from the definition of disability under Section 504 of the Rehabilitation Act. The rule, signed by Health and Human Services Secretary Robert F. Kennedy Jr. on October 29 and announced by the department's Office for Civil Rights on October 30, takes effect on January 4, 2027. It appeared in the Federal Register as document 2026-22380, on pages 69207 to 69223 of volume 91.

Section 504 bars discrimination on the basis of disability by hospitals, clinics, universities, state agencies and other bodies that receive federal money. The change is narrow in text but broad in reach, because HHS funding touches most of the American health system. Supporters describe the rule as a return to the words Congress wrote in 1990 and 1992. Opponents, including a coalition of 149 organizations, describe it as a step that will leave transgender people with fewer legal options when they face discrimination. The rule's publication lands on Election Day and adds to a run of federal actions on transgender policy this fall.

What the rule says

The final rule amends the department's Section 504 regulations at 45 CFR 84.4(g). The statute itself, at 29 U.S.C. 705(20)(F)(i), already says the term "individual with a disability" does not include a person on the basis of "transvestism, transsexualism, pedophilia, exhibitionism, voyeurism, gender identity disorders not resulting from physical impairments, or other sexual behavior disorders." The Americans with Disabilities Act contains the same list at 42 U.S.C. 12211(b).

HHS now states in its regulation that the phrase "gender identity disorders not resulting from physical impairments" covers "gender dysphoria not resulting from a physical impairment." The department says the text of the final rule is unchanged from the version it proposed on December 19, 2025.

The rule rests on a reading of medical history. When Congress wrote the exclusion into the ADA in 1990 and aligned the Rehabilitation Act in 1992, the edition of the American Psychiatric Association's diagnostic manual then in use, the DSM-III-R from 1987, used the term "gender identity disorder." The DSM-5, published in 2013, replaced that label with "gender dysphoria." HHS argues that "gender dysphoria amounts to a subset of gender identity disorders," so the statutory exclusion "necessarily" applies to it. The department also wrote that "evolving medical classifications of gender disorders cannot change the meaning of the statute."

HHS says the rule will not require funding recipients to "purchase new equipment, alter benefits, train employees, or change their practices in any way." It estimates the costs as negligible and does not put a dollar figure on the benefits. The only alternative the department says it weighed was to keep relying on an April 2025 notice instead of writing the point into regulation.

How the department got here

The dispute began with the preamble to a Biden administration rule. On May 9, 2024, HHS issued a broad update to its Section 504 regulations. The preamble, the explanatory text that runs ahead of the regulation, said that gender dysphoria was not within the statutory exclusions and could, in some cases, qualify as a disability. That preamble drew on a 2022 decision of the U.S. Court of Appeals for the Fourth Circuit.

A group of state attorneys general sued over the 2024 rule in Texas v. Kennedy, No. 5:24-cv-00225, in the Northern District of Texas. In April 2025 the new administration published a notice saying the gender dysphoria discussion in the preamble had no force of law. The proposed rule followed in December 2025, announced at an event alongside two Centers for Medicare and Medicaid Services rules on gender-related medical care for minors.

1. 1990The ADA excludes "gender identity disorders not resulting from physical impairments"
2. 1992Congress aligns the Rehabilitation Act definition
3. 2022Fourth Circuit rules in Williams v. Kincaid
4. 2024-05-09Biden-era Section 504 rule; preamble says gender dysphoria is not excluded
5. 2025-04-11HHS notice says that preamble has no force of law
6. 2025-12-19HHS proposes the regulatory change
7. 2026-02-20Extended comment period closes
8. 2026-10-29Secretary Kennedy signs the final rule
9. 2026-11-03Rule published in the Federal Register
10. 2027-01-04Rule takes effect

Source: Federal Register, 91 FR 69207

HHS extended the comment period from January 20 to February 20, 2026, citing technical problems and requests for more time over the holidays. The department says it received more than 380 comments from private citizens, health workers, educators, disability groups, faith-based groups, professional associations, state attorneys general and members of Congress. In the department's words, the comments "were divided in support for and opposition to the proposed rule."

HHS states that the Texas lawsuit shows the "confusion and legal risk" created by the 2024 preamble, "but it is not the main impetus for this rulemaking." The rule also cites Rapides Parish School Board v. HHS, a Louisiana case that challenged the 2024 rule on several grounds.

The Fourth Circuit problem

The rule's most direct legal tension is with Williams v. Kincaid, 45 F.4th 759 (4th Cir. 2022). In that case a transgender woman held in a Virginia jail sued under the ADA, and the Fourth Circuit held that her gender dysphoria was not excluded by the statute. The Supreme Court declined to hear the case in 2023.

HHS acknowledges in the rule that Williams "is binding precedent within federal courts in Maryland, North Carolina, South Carolina, Virginia, and West Virginia." It also notes that the Fourth Circuit is "the only circuit court to rule on the merits" of the question. The department argues that the decision "diverges with the rulings of numerous other courts" and lists district court rulings on both sides. It cites district court rulings such as Duncan v. Jack Henry and Associates in Missouri, Lange v. Houston County in Georgia and Doe v. Northrop Grumman in Alabama, which read the exclusion the way HHS does. It also acknowledges, with a "but see" citation, rulings such as Blatt v. Cabela's Retail in Pennsylvania and Doe v. Massachusetts Department of Correction that reached results like Williams.

In practice this means a hospital or school in those five states faces binding appellate precedent that points one way and a federal regulation that points the other. Commenters told HHS this would add to confusion rather than reduce it. The department replied that it was addressing the uncertainty that the 2024 preamble had created.

What HHS and its allies say

In an HHS press release, Kennedy tied the rule to his family's history with disability law. "My uncle Ted Kennedy was the primary author of the Americans with Disabilities Act," he said. He added that "the Biden-era pronouncements that indicated gender dysphoria may be a disability served the commercial interests of a predatory, multi-billion-dollar industry and betrayed the original intention of those laws."

Paula M. Stannard, director of the HHS Office for Civil Rights, said: "For decades, HHS' Section 504 regulations have defined disability consistently with the words Congress chose. This rule ensures recipients of HHS funding follow those definitions, eliminating confusion for the people they serve and restoring confidence in the statute." The release cites President Donald Trump's executive orders 14168 and 14219, the first of which directs agencies to recognize two sexes.

Conservative legal groups made the same argument against the Biden-era approach. In a 2023 comment, Greg Baylor of Alliance Defending Freedom said HHS was working "to enshrine 'gender dysphoria' as a disability in federal law via regulation—something Congress purposely excluded from the statutory language." The group also raised concerns about religious liberty, single-sex spaces and sports. Scholars at the Ethics and Public Policy Center called the earlier HHS position "unconvincing and unlawful."

In the rule, HHS answered commenters who said the change was driven by hostility toward transgender people. "This final rule is not based on an effort to harm a population for political gain," the department wrote, describing its reading as "the best reading of the statute."

What opponents say

The National Women's Law Center, which says it led a coalition of 149 organizations in opposing the rule, criticized it on November 2. "The administration is once again abusing its power to target the trans community," said Ma'ayan Anafi of the center. "This final rule will invite and even encourage illegal discrimination," she said.

The Disability Rights Education and Defense Fund argues that gender dysphoria is a distinct condition from the "gender identity disorder" Congress named. DREDF says that 26 of 31 court decisions since 2013 have held that gender dysphoria is not automatically excluded from disability protections. It also points to the ADA Amendments Act of 2008, in which Congress told courts to read the definition of disability broadly. "This rule is not about clarity. It is about exclusion," said Michelle Uzeta of DREDF.

DREDF cites figures from the 2022 U.S. Transgender Survey on negative experiences with health care providers. The survey is a large self-selected sample, not a representative poll, so the figures describe respondents rather than all transgender adults.

0%

20%

40%

60%

All respondents47%

Disabled respondents58%

All respondentsDisabled respondents

Source: DREDF statement, Nov. 2, 2026

Show the numbers

Group	Share
All respondents	47%
Disabled respondents	58%

Commenters also told HHS that statements by Kennedy and other officials showed animus toward transgender people. The department rejected that claim in the rule.

Who is affected

Section 504 applies to any program that receives HHS money. That includes most hospitals through Medicare and Medicaid, community health centers, state health and social service agencies, and many universities and medical schools. A person who believes they were treated unfairly because of a disability can file a complaint with the HHS Office for Civil Rights or, in many cases, sue.

The rule does not ban gender-affirming care, and it does not change other federal laws. Its effect is to tell HHS's civil rights office and funding recipients that the department will not treat gender dysphoria, absent a physical cause, as a disability in its own enforcement. A transgender patient could still claim protection based on a different disability, and the rule leaves state disability and civil rights laws untouched. Several states have their own laws that protect gender identity.

The change follows other federal steps on transgender health policy. A Centers for Medicare and Medicaid Services rule that bars Medicaid and CHIP funding for certain gender-related procedures for minors took effect on October 13, 2026. On October 21 the Supreme Court denied a request to pause lower court orders in a federal prison medical care case, with Justices Clarence Thomas and Samuel Alito noting they would have granted it. 567politics has also covered Kansas's law on transgender driver's licenses and voter ID and Virginia's ballot questions on reproductive freedom and same-sex marriage as part of this election cycle.

Public opinion

567politics did not find a representative national poll that asks specifically whether gender dysphoria should count as a disability under federal civil rights law. Broader polls on transgender policy exist, but they ask different questions, so this story does not cite them as evidence of views on this rule.

What comes next

The rule takes effect on January 4, 2027, unless a court blocks it. As of Tuesday morning 567politics had not found a lawsuit filed against the final rule. Opponents could argue that it conflicts with Williams in the Fourth Circuit, that it is arbitrary under the Administrative Procedure Act, or that it misreads the ADA Amendments Act. Supporters could point to the statute's text and to district court rulings that agree with HHS.

The Texas v. Kennedy case, which challenged the 2024 rule, may also be affected, since the department has now addressed the preamble that the states objected to. Congress could also settle the question by amending the statute.

For a wider view of how candidates and officials are rated on LGBTQ policy and health care, see the 567politics United States issues guide. Health policy readers may also want our report on 2027 ACA premiums and subsidies.

How we reported this

This story is based on the Federal Register text of the final rule, the HHS press release, and statements from the National Women's Law Center, DREDF, Alliance Defending Freedom and the Ethics and Public Policy Center. 567politics checked its government datasets tool and found no dataset that measures the effects of this rule, so the story relies on the primary federal document. The site's funding tool has no verified Federal Election Commission snapshot for Secretary Kennedy or President Trump, so this story makes no claims about their campaign funding. Quotes come from the sources linked above. Our methodology and editorial standards explain how we choose and check sources.

Differing perspectives

Should federal disability law treat gender dysphoria that does not result from a physical impairment as a possible disability?

Each position is summarized as its supporters make it, with equal weight and in alphabetical order. A summary is not an endorsement; the evidence for each is weighed in the story above.

• Apply broad disability coverage case by case

  Who holds it: Disability Rights Education and Defense Fund and other disability rights advocates

  Disability rights advocates say gender dysphoria is a distinct diagnosis from the gender identity disorder Congress named, and that most courts to rule since 2013 have held it is not automatically excluded. They point to the ADA Amendments Act of 2008, which told courts to read disability broadly, and to the Fourth Circuit's Williams ruling. They argue each person's condition should be assessed under the normal disability test rather than removed from coverage by regulation.

  In their words: Disability Rights Education and Defense Fund ↗

• Keep the exclusion in the rule

  Who holds it: HHS Secretary Robert F. Kennedy Jr., the HHS Office for Civil Rights, Alliance Defending Freedom

  Supporters say Congress wrote the exclusion for gender identity disorders into the ADA in 1990 and the Rehabilitation Act in 1992, and that gender dysphoria is a later name for a subset of those conditions. They say changing diagnostic labels cannot change what a statute means. They argue the rule removes confusion caused by the 2024 preamble, asks nothing new of hospitals or schools, and keeps HHS enforcement tied to the words Congress chose rather than to agency interpretation.

  In their words: HHS press release ↗

• Withdraw the rule

  Who holds it: National Women's Law Center and a coalition of 149 organizations it led

  Opponents say the rule singles out transgender people and narrows civil rights protections that courts have recognized. They argue it will encourage health providers and other federally funded bodies to deny care or accommodations, and that it leaves transgender patients with fewer ways to challenge unfair treatment. They say the department is twisting the law and misusing its power against a group Section 504 should protect, and they want the rule withdrawn.

  In their words: National Women's Law Center ↗