What Happened?

If you have gender dysphoria not caused by a physical impairment and receive services from programs funded by the Department of Health and Human Services, a finalized HHS rule takes effect Jan. 4, 2027 and excludes that condition from disability protections under Section 504 of the Rehabilitation Act. ​

The U.S. Department of Health and Human Services (HHS) finalized a rule in a Federal Register document dated Nov. 3, 2026, that excludes gender dysphoria not resulting from a physical impairment from disability protections.

Section 504 of the Rehabilitation Act, a federal civil rights law, bars programs that receive federal money from discriminating against people with disabilities.The rule reverses a position HHS took in a May 2024 final rule, whose preamble stated that gender dysphoria did not fall within the law's exclusions.

Why Does it Matter to Me?

HHS says individuals may still have protections under other federal nondiscrimination laws, including Title VI, Title IX, and the Age Discrimination Act, and may still use Section 504 for other qualifying disabilities. Gender dysphoria that does result from a physical impairment is not automatically excluded and may still qualify if the standard disability criteria are met.

Commenters warned that excluding gender dysphoria would lead to people being turned away from basic services and contribute to poor health outcomes, including depression, anxiety, and suicide.

Both Sides, Now

HHS says the rule clears up ambiguity left by the 2024 rule and reaffirms a statutory exclusion Congress put in place when it enacted the Americans with Disabilities Act in 1990, later applied to the Rehabilitation Act in 1992. The department says it "does not intend to convey any position on the legitimacy, morality, or proper treatment of gender dysphoria not resulting from physical impairments," and describes costs to federally funded recipients as negligible.

Opponents argue the rule removes a meaningful legal shield. In a 2022 case, *Williams v. Kincaid*, the Fourth U.S. Circuit Court of Appeals ruled that a transgender woman with gender dysphoria who alleged a Virginia jail placed her in a men's facility and denied her care had plausibly alleged her condition was not covered by the ADA's exclusion, according to Justia. HHS acknowledged that ruling is binding in Maryland, North Carolina, South Carolina, Virginia, and West Virginia, but argued it does not support the department's reading of the statutory exclusion. HHS says the rule is consistent with Executive Order 14192.

What Happens Next?

Three states urged HHS to rescind the entire 2024 final rule, but HHS said that request was outside the scope of this rulemaking.

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