1
January 20, 2026
U.S. Department of Health and Human Services
Office for Civil Rights
Hubert H. Humphrey Building, Room 509F
200 Independence Avenue SW, Washington, DC 20201
Submitted electronically
RE:

RIN 0945-AA27
Nondiscrimination on the Basis of Disability in Programs or Activities Receiving
Federal Financial Assistance

The 114 undersigned organizations write to express our strong opposition to the U.S. Department
of Health and Human Services’ (HHS) proposed rule “Nondiscrimination on the Basis of Disability
in Programs or Activities Receiving Federal Financial Assistance.” As a coalition of organizations
spanning across communities—including organizations advocating for disability rights and justice,
LGBTQI+ equality, gender justice, and civil rights broadly—we reject HHS’ attempts to weaken
nondiscrimination protections for people with gender dysphoria. Contrary to HHS’ claims, the
proposed rule is unjustified, unwarranted, and contrary to the spirit and letter of the law. It would
likely result in wide-ranging harm for people seeking to access critical services, disregard
established case law, and conflict with the language and intent of Section 504. We are steadfastly
opposed both to HHS’ proposed rule and its concerted effort to erode the rights of people with
gender dysphoria and transgender people more broadly.
HHS proposes to codify an exclusion of “gender dysphoria not resulting from physical
impairments” in regulations promulgated under Section 504 of the Rehabilitation Act of 1973, as
an attempt to carve out gender dysphoria from disability nondiscrimination protections applicable
to HHS-funded programs and activities. This proposal suffers from substantive deficiencies that
we outline throughout this comment. Among other shortcomings, HHS fails to consider the
hardships the rule would impose on individuals facing discrimination; fails to adhere to the
underlying purpose and rules of construction of Section 504; and fails to address the reasoning
of numerous court decisions rejecting the exclusion of gender dysphoria from disability
nondiscrimination laws. Given these serious deficiencies, HHS must withdraw the proposed rule
in its entirety.

I.

HHS fails to account for the harm that would result from the proposed rule.

If finalized, the proposed rule would impose lasting and far-reaching burdens on both individuals
entitled to Section 504’s guarantees and on covered entities. The prospective rule would promote
discrimination against people with disabling1 gender dysphoria in critical health and human
1

As with all conditions, the analysis of whether gender dysphoria is disabling and thus qualifies for
protections under Section 504 is determined through a case-by-case analysis of whether a particular

2
service programs, as well as create confusion and potential liability for covered entities. HHS’
failure to account for or even meaningfully acknowledge this harm raises serious questions about
whether it has disregarded crucially important evidence it is obligated to consider.
I-A. The proposed rule would harm individuals accessing HHS-funded activities and programs.
The proposed revisions to Section 504’s implementing regulations would invite discrimination
against people with gender dysphoria, as well as those regarded as having gender dysphoria or
who have a history of the condition.2 Individuals accessing critical federally funded health and
human services could face denials of care and benefits, mistreatment, and other forms of
discrimination. For example, eroding protections in HHS-funded programs and services could:
●
●
●
●

lead people with gender dysphoria to be turned away when seeking medical care,
regardless of whether the care they need is related to gender dysphoria;
encourage discriminatory treatment in health settings, based on bias or stereotypes about
people with gender dysphoria;
subject children, parents, caregivers, foster parents, and prospective parents with gender
dysphoria to exclusion and discrimination in child welfare settings; and
exclude people with gender dysphoria and their families from participation in services for
individuals experiencing poverty, such as Head Start, the school-readiness program for
families with low incomes, and assistance for older adults provided through the
Administration for Community Living.

Such discrimination can have a range of repercussions for individuals, threatening their health,
security, and overall well-being. For example, denial of medical care jeopardizes health in both
the short- and long-term, compounding existing population-specific health disparities. Individuals
and families facing discrimination in human services could lose access to benefits like nutrition
assistance, child care support, and home energy assistance programs, risking their safety, health,
and financial stability. The prevalence of discrimination itself can magnify these harms by
deterring people from seeking needed services for fear of mistreatment.3
Indeed, the proposed rule would exacerbate barriers that people with gender dysphoria already
face when accessing health and human services. Data on the experiences of transgender people
individual’s gender dysphoria substantially limits one or more of their major life activities. Courts have
recognized that gender dysphoria can potentially impact a range of major life activities, including, among
others, “interacting with others, reproducing, and social and occupational functioning.” See Blatt v.
Cabela’s Retail, Inc., No. 5:14-CV-04822, 2017 WL 2178123, at *4 (E.D. Pa. May 18, 2017).
2
The term “people with gender dysphoria” is used throughout this comment for brevity, and it is intended
to include people regarded as having gender dysphoria and people with a history of gender dysphoria.
3
Research on the experiences of transgender people broadly, including those with gender dysphoria,
indicates that many postpone or forgo needed healthcare and other necessary services due to concerns
about mistreatment and discrimination. E.g., Ankit Rastogi et al., Health and Wellbeing: A Report of the
2022 U.S. Transgender Survey 28 (Jun. 2025), https://transequality.org/sites/default/files/202506/USTS_2022Health%26WellbeingReport_WEB.pdf; Caleb Smith & Haley Norris, The LGBTQI+
Community Reported High Rates of Discrimination in 2024 (Mar. 12, 2025),
https://www.americanprogress.org/article/the-lgbtqi-community-reported-high-rates-of-discrimination-in2024.

3
generally, many of whom experience gender dysphoria, sheds light on the barriers that people
with gender dysphoria may face. For example, a 2022 study of 92,329 transgender people
revealed that, in just the previous year, approximately half (47%) had a negative experience with
a health provider related to being transgender, such as being turned away, denied medical care,
or verbally or physically harassed.4 This mistreatment was even more common among
respondents who identified as having a disability, with 58% reporting one or more of these
negative experiences.5
Similarly, research has also revealed experiences of discrimination in human services, many of
which may receive HHS funding. For example, transgender youth are vastly overrepresented in
foster care settings, with one study finding that those in foster care are nearly five times as likely
to be transgender as youth overall.6 Studies of LGBTQ+ youth overall indicate that while they are
in foster care, they are more likely than their peers to face mistreatment, isolation, and placement
instability, leading to worse outcomes for their health, educational attainment, safety, and financial
security.7
The prevalence and ramifications of such experiences in health and human services demand a
robust enforcement of all nondiscrimination laws under HHS’ purview, including Section 504’s
protections for people with gender dysphoria. But instead of seeking to ameliorate these existing
barriers, HHS has proposed a rule that would worsen them, leaving people with gender dysphoria
vulnerable to an even higher risk of mistreatment and undermining the legal recourse they may
need to address the discrimination they face.
In addition to the harm it threatens for people with gender dysphoria broadly, the rule may also
lead to increased discrimination against intersex people, potentially leading to significant harms
that the proposed rule did not address. HHS’ proposed reinterpretation could have the practical
effect of imposing barriers for intersex people, who may also experience gender dysphoria, 8 when
they seek Section 504’s protections. Covered entities may be confused about the scope of the
rule, or they may regard an intersex individual as falling within the exclusion as HHS has
interpreted it—a perception that may be independent of whether they in fact experience gender
dysphoria or whether the gender dysphoria they may experience can be said to result from
“physical impairments.” Covered entities may demand that an intersex individual “prove” their
4

Rastogi et al., supra note 3 at 30.
Id. at 31.
6
Laura Baams et al., LGBTQ Youth in Unstable Housing and Foster Care, 143 PED.
e20174211 (Mar. 2019), http://doi.org/10.1542/peds.2017-4211.
7
See, e.g., id.; Eduardo Gutierrez, Queer and Vulnerable: Identifying the Challenges of LGBTQ+ Youth in
Foster Care (Mar. 2024), https://chci.org/wp-content/uploads/2024/04/FINAL.Gutierrez-Eduardo.pdf.
8
See, e.g., Paulo Sampaio Furtado et al., Gender Dysphoria Associated with Disorders of Sex
Development, 9 NAT. REV. UROL. 620 (Nov. 2012), http://doi.org/10.1038/nrurol.2012.182 (reporting
average rates of gender dysphoria at 5% for Complete Androgen Insensitivity Syndrome, 10% for
Congenital Adrenal Hyperplasia, 12.5% for Ovotesticular DSD, 20% for Partial Androgen Insensitivity
Syndrome, and 29% for Mixed Gonadal Dysgenesis); Peggy T. Cohen-Kettenis, Gender Change in 46,XY
Persons With 5-a-Reductase-2 Deficiency and 17-B-Hydroxysteroid Dehydrogenase-3 Deficiency, 34
ARCHIV. SEX. BEHAV. 399 (Aug. 2005), https://doi.org/10.1007/s10508-005-4339-4 (reporting rates of
gender dysphoria up to 63% and 64% for these two patient groups).
5

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intersex variation to obtain an accommodation or otherwise benefit from nondiscrimination
protections, potentially delaying or limiting that intersex individual’s access to needed and often
time-sensitive services. Under the proposed rule, intersex people therefore may face greater
barriers to accessing critical health and human services, exacerbating the considerable barriers
to quality care and the health disparities they already experience.9
I-B. The proposed rule would create confusion for HHS-funded entities.
Despite the proposed rule’s assertion that gender dysphoria is excluded from the definition of
"disability," HHS-funded programs and activities would continue to be subject to statutory
requirements independent of the rule. Section 504’s prohibition on discrimination based on gender
dysphoria, as affirmed by numerous courts, cannot be nullified by regulation, and covered entities
must still meet their obligations under the statute. A rule that runs contrary to this statutory
obligation would create confusion for covered entities, opening the door to or even tacitly
encouraging violations of the law that would render them vulnerable to legal liability. The
confusion this rule would engender could reach even beyond the HHS-funded entities to which it
applies: It may leave entities funded by other federal agencies uncertain about the meaning of
the statute in its full range of applications or about how other agencies may enforce it.
I-C. The proposed rule misrepresents the reliance interests it undermines.
HHS asserts that the proposed rule’s effects on any reliance interests are minimal because the
discussion of gender dysphoria in the preamble to the Section 504 rule promulgated in 2024 was
not enforceable, and to the extent anyone relied on it, they would have “no legitimate reliance
interest in maintaining that language, and indeed would be harmed by its continuation.” HHS does
not, and cannot, offer any explanation for its claim that those who relied on the preamble would
be harmed unless the proposed rule is adopted. Further, this claim disregards the source of the
reliance interests: not the recent preamble but the decade of case law recognizing that gender
dysphoria can be a disability, as well as the text of the statute itself. Indeed, the impugned
preamble did little more than acknowledge existing case law and indicate HHS’ intent to comply
with it.
II.

The proposed rule runs contrary to the language and purpose of the statute and the
case law interpreting it.

HHS asserts that the existing exclusion of “gender identity disorders not resulting from physical
impairments” from the definition of “disability” under Section 504 necessarily includes “gender
dysphoria not resulting from physical impairments.” This claim, however, is contrary to the
statutory language, the overwhelming body of case law, and Congress’ express directive for
“disability” to be broadly interpreted.

9

See Caleb Smith, The Intersex Community Faced Significant Barriers and Challenges in 2024 (Jun. 25,
2025), https://www.americanprogress.org/article/the-intersex-community-faced-significant-barriers-andchallenges-in-2024.

5
II-A. The proposed rule misinterprets the statutory language.
As numerous courts have recognized, the best reading of “gender identity disorders not resulting
from physical impairments” does not encompass gender dysphoria. The proposed rule’s claim
that the distinction between gender identity disorder and gender dysphoria is “merely linguistic”
disregards key differences between the two conditions. While gender dysphoria as a diagnostic
category has evolved from conditions previously recognized by the medical community, it differs
from gender identity disorders to such a degree that the statutory language cannot be said to
apply to gender dysphoria.
The core feature of “gender identity disorders” (GIDs) was, as the name suggests, having a
disordered identity—a “mental illness” that resulted in one’s wanting to be, or believing that one
actually was, something they were not.10 As the Fourth Circuit concluded in Williams v. Kincaid,
the diagnosis pathologized transgender identity.11 Under the DSM-III-R, “mild” cases included “the
person [who] is aware that he is a male or she is a female” but feels “uncomfortable” about this,
as well as “severe” cases, “as in Transsexualism, [where] the person not only is uncomfortable
with the assigned sex but has the sense of belonging to the opposite sex.” 12
The core feature of gender dysphoria, by contrast, is clinically significant distress (i.e., emotional
suffering) or impairment in social, occupational, or other areas of functioning (i.e., difficulty
performing daily life functions regardless of whether one experiences emotional suffering).13 The
diagnostic criteria for gender dysphoria reject the foundational assumptions upon which the
diagnosis of GID was premised—that is, that the presenting feature of the condition was a
purportedly “disordered” identity.14 For people with gender dysphoria, identity is not a problem in
need of treatment—dysphoria is.15
Contrary to HHS’ argument, the DSM’s shift between GIDs and gender dysphoria is more than a
superficial attempt to reorganize or rephrase diagnostic criteria. Rather, as Williams correctly
concluded, the changes in the DSM reflect substantive shifts in clinical understanding. They
demonstrate that gender dysphoria is not the same as, and is not encompassed by, GIDs. As

10

See Diagnostic and Statistical Manual of Mental Disorders 71 (3rd ed., rev.) (1987) [hereinafter DSMIII-R]; Williams v. Kincaid, 45 F.4th 759, 767 (4th Cir. 2022).
11
45 F.4th at 767 (“[I]n 1990, the gender identity disorder diagnosis marked being transgender as a
mental illness.”); id. at 769 (noting that “the older DSM pathologized the very existence of transgender
people”).
12
DSM-III-R at 71.
13
See American Psychiatric Ass’n, Diagnostic and Statistical Manual of Mental Disorders 452–53 (5th ed.
2013) [hereinafter DSM-5].
14
See id. at 451.
15
See Williams, 45 F.4th at 767 (“[A] diagnosis of ‘gender identity disorder . . . indicat[ed] that the clinical
problem was the discordant gender identity.”) (quoting Grimm v. Gloucester Cnty. Sch. Bd., 972 F.3d 586,
611 (4th Cir. 2020)); id. at 768 (“[A] diagnosis of gender dysphoria, unlike that of ‘gender identity disorder
[ ],’ concerns itself primarily with distress and other disabling symptoms, rather than simply being
transgender.”). See also DSM-5 at 451 (“The current term is more descriptive than the previous DSM-IV
term gender identity disorder and focuses on dysphoria as the clinical problem, not identity per se.”).

6
Williams rightly notes, the former cannot simply be collapsed into the latter, any more than “anxiety
disorder” is the same as or is subsumed by “hysteria.”16
II-B This rule disregards the overwhelming majority of case law from the past decade.
Courts have overwhelmingly agreed that gender dysphoria is not categorically excluded from
Section 504 or under mirroring language in the ADA. Since the publication of the DSM-5 and
emergence of the diagnosis of gender dysphoria in 2013, the vast majority of cases addressing
the issue—twenty-six out of thirty-one (84%)—have concluded that gender dysphoria is not
categorically excluded from Section 504 or the ADA. 17 Indeed, every court that has addressed the
16

See Williams, 45 F.4th at 769 n.5; see also id. at 767 (“[I]n 1990, the medical community did not
acknowledge gender dysphoria either as an independent diagnosis or as a subset of any other
condition.”).
17
Williams, 45 F.4th at 766–69 (holding that gender dysphoria is not categorically excluded), cert. denied,
143 S. Ct. 2414 (2023); accord Doe v. Horne, No. CV-23-00185, 2024 WL 3091984, at *3 (D. Ariz. June
21, 2024); Doe v. Ga. Dep’t of Corr., 730 F. Supp. 3d 1327, 1348 (N.D. Ga. 2024); Kozak v. CSX Transp.,
Inc., No. 20-CV-184S, 2023 WL 4906148, at *6–7 (W.D.N.Y. Aug. 1, 2023); Fly v. United States, No. 18cv-063, 2023 WL 10447544, at *21 (D.N.D. Dec. 15, 2023) (assuming that gender dysphoria is covered
by ADA and dismissing ADA claims on other grounds), report and recommendation adopted in relevant
part, 2024 WL 1188806 (D.N.D. Jan. 29, 2024); Guthrie v. Noel, No. 1:20-CV-02351, 2023 WL 8115928,
at *1 (M.D. Pa. Sept. 11, 2023), report and recommendation adopted, 2023 WL 8116864, at *1 (M.D. Pa.
Sep. 29, 2023); Melnick v. Polis, No. 21-cv-01695, 2023 WL 11918117, at *3 (D. Colo. Dec. 1, 2023)
(assuming without deciding that gender dysphoria is a disability under ADA and dismissing claim on other
grounds); Griffith v. El Paso Cnty., Colorado, No. 21-cv-00387, 2023 WL 2242503, at *17–18 (D. Colo.
Feb. 27, 2023) (holding that GIDs exclusion does not apply to gender dysphoria, and rejecting reasoning
of pre-DSM-5 case in same district, Michaels v. Akal Sec., Inc., No. 09-cv-01300, 2010 WL 2573988 (D.
Colo. June 24, 2010), as outdated and summarily reasoned), report and recommendation adopted, 2023
WL 3099625 (D. Colo. Mar. 27, 2023), vacated in part on other grounds, 129 F.4th 790, 835 (10th Cir.
2025); Pinson v. Fed. Bureau of Prisons, No. 3:23-CV-384, 2023 WL 8358067, at *3 (D. Conn. Dec. 1,
2023); Gregory v. Jeffreys, No. 21-1097, 2022 WL 617408, at *6 (C.D. Ill. Mar. 2, 2022) (allowing plaintiff
to proceed for purposes of notice pleading with a claim that gender dysphoria is covered by ADA); Gibson
v. Cmty. Dev. Partners, No. 3:22-cv-454, 2022 WL 10481324, at *7 (D. Or. Oct. 18, 2022) (“assuming
without deciding that gender dysphoria is a disability” and dismissing ADA and Rehabilitation Act claims
on other grounds); Alexander v. Mass. Dep’t of Corr., No. 20-10020, 2022 WL 1407946, at *7 (D. Mass.
May 4, 2022) (denying motion to dismiss incarcerated plaintiff’s ADA claim alleging discrimination based
on gender dysphoria); Sutton v. Washington, No. C19-1500, 2021 WL 9782776, at *18–19 (W.D. Wash.
July 21, 2021) (treating gender dysphoria as a disability under ADA and Rehabilitation Act and granting
summary judgment to state on other grounds), report and recommendation adopted in relevant part, 2022
WL 16707276, at *10 (W.D. Wash. 2022); Shorter v. Garland, No. 19cv108, 2021 WL 6062280, at *1–2
(N.D. Fla. Dec. 22, 2021) (finding that the GIDs exclusion “does not provide a basis for granting . . .
summary judgment” and rejecting report and recommendation that stated, without reasoning, that
“‘[g]ender dysphoria, as a gender identity disorder . . . is specifically exempted as a disability by the
Rehabilitation Act’” (quoting Shorter v. Barr, No. 19cv108, 2020 WL 1942785, at *9–10, 10 n5 (N.D. Fla.
Mar. 13, 2020))); Doe v. Hosp. of Univ. of Pa., 546 F. Supp. 3d 336, 348-509 (E.D. Pa. 2021); Doe v. Pa.
Dep’t of Corrs., No. 20-cv-00023, 2021 WL 1583556, at *7–12 (W.D. Pa. Feb. 19, 2021), report and
recommendation adopted in relevant part, 2021 WL 1115373, at *3 (W.D. Pa. Mar. 24, 2021); Venson v.
Gregson, No. 18-cv-2185, 2021 WL 673371, at *2–3 (S.D. Ill. Feb. 22, 2021) (rejecting argument that “for
all practical purposes [gender dysphoria] is equivalent to ‘gender identity disorder’ because gender
identity is still at the crux of Plaintiff’s diagnosis,” and holding a prison failed to properly accommodate a
transgender person); Doe v. Triangle Doughnuts, LLC, 472 F. Supp. 3d 115, 134–35 (E.D. Pa. 2020); Tay
v. Dennison, No. 19-cv-00501, 2020 WL 2100761, at *3 (S.D. Ill. May 1, 2020); Castle v. Cobb Cnty., No.
1:19-CV-01406, 2022 WL 1569705, at *2 (N.D. Ga. May 18, 2022); Iglesias v. True, 403 F. Supp. 3d 680,

7
issue since Williams has reached this conclusion. A small minority of just five cases, all decided
before the Fourth Circuit’s 2022 decision in Williams, have concluded otherwise.18
Interpreting the GIDs exclusion to encompass gender dysphoria would also implicate
constitutional concerns. As the Fourth Circuit explained in Williams, and as numerous district
courts have similarly concluded, there is “no legitimate reason” why Congress would intend to
exclude people with gender dysphoria from disability nondiscrimination protections; the only
reason to be “glean[ed] from the text and legislative record is ‘a bare . . . desire to harm a politically
unpopular group,’” which “cannot constitute a legitimate governmental interest.”19
II-C The proposed rule is contrary to the rules of construction codified by Congress.
In 2008, after a series of four Supreme Court decisions narrowly construing the definition of
disability under the ADA,20 Congress enacted the ADA Amendments Act of 2008 (ADAAA). This
law amended the ADA’s and Section 504’s definition of disability by, inter alia, instructing courts
to construe “[t]he definition of disability in this chapter . . . in favor of broad coverage of individuals
under this chapter, to the maximum extent permitted by the terms of this chapter.”21 As the Fourth
Circuit observed in Williams, the meaning of these words is plain: The court must construe the
definition of disability broadly, and its exclusions narrowly.22 To interpret the GIDs exclusion

686–88; London v. Evans, No. 19-559, 2019 WL 5726983, at *6 (D. Del. Nov. 5, 2019); Harvard v. Inch,
411 F. Supp. 3d 1220, 1240, 1245 (N.D. Fla. 2019); Edmo v. Idaho Dep’t of Corrs., No. 17-cv-00151,
2018 WL 2745898, at *7–8 (D. Idaho Jun. 7, 2018); Doe v. Mass. Dep’t of Corrs., No. 17-12255, 2018 WL
2994403, at *6 (D. Mass. Jun. 14, 2018); Blatt, No. 14-cv-4822, 2017 WL 2178123, at *3.
18
See Duncan v. Jack Henry & Assocs., Inc., 617 F. Supp. 3d 1011, 1056–57 (W.D. Mo. 2022) (holding
GIDs exclusion “encompasses . . . diagnosis of gender dysphoria”); accord Lange v. Houston Cnty., 608
F. Supp. 3d 1340, 1360–63 (M.D. Ga. 2022); Doe v. Northrop Grumman Sys. Corp., 418 F. Supp. 3d 921,
929–30 (N.D. Ala. 2019); Parker v. Strawser Constr., Inc., 307 F. Supp. 3d 744, 753–54 (S.D. Oh. 2018);
Gulley-Fernandez v. Wis. Dep’t of Corr., No. 15-cv-995, 2015 WL 7777997, at *1–3 (E.D. Wis. Dec. 1,
2015). One of these cases, Gulley-Fernandez, is of little to no interpretive value. That case was litigated
by an incarcerated plaintiff appearing pro se. Gulley-Fernandez, 2015 WL 7777997, at *1. Unsurprisingly,
the court summarily concluded in a single sentence, without any analysis whatsoever, that gender
dysphoria was excluded by the ADA. Id. at *3. Unlike Blatt and many subsequent cases, GulleyFernandez did not analyze whether the GIDs exclusion applies to the new diagnosis of gender dysphoria
nor whether the exclusion violates equal protection, see id. at *1–4, and the court reached its decision
without the benefit of a statement of interest filed by the Department of Justice or an amicus brief filed by
state or national transgender rights organizations, see generally Gulley–Fernandez, No. 15-cv-995 (E.D.
Wis).
19
Williams, 45 F.4th at 773 (citing Grimm for proposition that “the ADA’s exclusion of gender identity
disorders [was] itself . . . evidence of such discriminatory animus”); see also Doe v. Pa. Dep’t of Corr., No.
20-cv-00023, 2021 WL 1583556, at *11 (W.D. Pa. Mar. 24, 2021); Doe, No. 17-12255, 2018 WL
2994403, at *8; Blatt, No. 5:14-cv-04822, 2017 WL 2178123, at *4.
20
See Americans with Disabilities Act Amendments Act of 2008 § 2 (b)(2)–(4) , Pub. L. No. 110-325, 122
Stat. 3553, 3554 (2008) (stating that part of the purpose was to reject the reasoning of “the Supreme
Court in Sutton v. United Air Lines, Inc., 527 U.S. 471 (1999) and its companion cases [Murphy v. United
Parcel Serv., Inc., 527 U.S. 516 (1999) and Albertson’s, Inc. v. Kirkingburg, 527 U.S. 555 (1999)]” and “in
Toyota Motor Manufacturing, Kentucky, Inc. v. Williams, 534 U.S. 184 (2002)”).
21
42 U.S.C. § 12102(4)(A).
22
See Williams, 45 F.4th at 766 (“Congress expressly directed courts to construe the amended [ADA] as
broadly as possible. Moreover, because the 2008 amendments to the ADA were intended to make it

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broadly to apply to gender dysphoria, the Fourth Circuit concluded, would violate the plain
meaning of the law. It would “rewrite the statute in two impermissible ways: by penciling a new
condition into the list of exclusions, and by erasing Congress’s command to construe [the statute]
as broadly as the text permits.”23
The proposed rule ignores this plain meaning. Section 504’s “broad coverage” provision requires
courts to construe the definition of disability broadly “under this chapter,” i.e., throughout the entire
statute—not select parts of it.24 As a matter of logic, construing the definition of disability broadly
throughout the entire statute requires construing exceptions to the definition of disability
narrowly.25 Had Congress wanted to limit the reach of the “broad coverage” provision, it could
have explicitly carved the GIDs exclusion out of that provision as it did with respect to other
provisions in the ADAAA.26 Congress did no such thing. HHS’ assertion that gender dysphoria is
excluded from Section 504’s definition of disability represents an unwarranted and unnecessarily
restrictive interpretation of the statute—flatly contradicting the ADAAA’s explicit purpose to
“reinstat[e] a broad scope of protection.”27

III.

The misrepresentations and baseless claims underlying the proposed rule further
demonstrate it cannot be supported.

III-A HHS’ claim that excluding people with gender dysphoria is necessary to protect people with
other disabilities is false.
HHS asserts that recognizing protections for people with gender dysphoria undermines the
integrity of Section 504 and endangers its guarantees of nondiscrimination for people with other
disabilities. For example, when presenting the rationale for the proposed rule, HHS Secretary
Robert F. Kennedy Jr. claimed that recognizing gender dysphoria as a potential disability
“betrayed the original intention of those laws and gendered [sic] widespread public resentments
against those laws among the American people and discredit the statutes in the public mind.” 28
Doing so, he added, “injures the statutes themselves and injures other people who are entitled to
easier for people with disabilities to obtain protection under the ADA, courts must construe the ADA’s
exclusions narrowly.”) (citation modified).
23
Id. at 770; see also id. at 769–70 (“[G]iven Congress’ express instruction that courts construe the ADA
in favor of maximum protection for those with disabilities, we could not adopt an unnecessarily restrictive
reading of the ADA.”).
24
See 42 U.S.C. § 12102(4)(A) (“The definition of disability in this chapter shall be construed in favor of
broad coverage of individuals under this chapter, to the maximum extent permitted by the terms of this
chapter.”) (emphasis added).
25
See Williams, 45 F.4th at 766.
26
See, e.g., ADA Amendments Act § 3(4)(E)(ii), 122 Stat. at 3557 (stating that the ADA’s prohibition on
consideration of “the ameliorative effects of mitigating measures” in determining whether a person has a
disability does not apply to the ameliorative effects of “ordinary eyeglasses or contact lenses”); id.
§(6)(a)(1)(g) (stating that the ADA’s prohibition on discrimination “on the basis of disability” does not apply
to discrimination “because of the individual’s lack of disability”).
27
Id. § 2(b)(1).
28
Dep’t of Health & Human Servs., Protecting Children, at 6:06 (YouTube, Dec. 18, 2025),
https://www.youtube.com/watch?v=aY1XfN6Tt0Q&t=2189s.

9
that protection and who Americans want to see protected.”29 This argument, offered with no
evidence beyond conjecture, appears to be little more than an effort to stigmatize people with
gender dysphoria, appropriate the concerns of the disability community, and weaponize a civil
rights statute to promote discrimination.
As a coalition that includes numerous organizations that have long fought for disability rights and
justice, we firmly reject HHS’ claim that it is acting on behalf of people with disabilities in proposing
this rule. Recognizing Section 504’s guarantees for all whom Congress intended to protect in no
way weakens those guarantees for other people with disabilities. To the contrary, efforts to limit
Section 504’s coverage do a disservice to all people with disabilities. The breadth and diversity of
the disability community have always been critically important to its strength. Further, people with
disabilities have long rejected the notion that federal disability rights laws should protect only a
narrow set of people viewed as “the truly disabled,” and Congress rejected that notion as well in
the ADAAA.
III-B The animus that appears to motivate the proposed rule cannot justify rulemaking.
While the proposed rule asserts that it is driven by statutory interpretation, the reasoning HHS
has proffered for the rule suggests a motivation that is, in whole or part, based on a bare desire
to harm people with gender dysphoria and transgender people more broadly. For example, when
Deputy Secretary Jim O’Neill introduced the proposed rule—one of several concurrent actions
HHS announced targeting transgender people—he prefaced it with false and inflammatory
justifications, including that recognizing the existence of transgender people represents a “denial
of fundamental truths” that “can destroy nations from within,” that it is “at the root of the evils we
face,” and that it demonstrates “a hatred for nature as God designed it and for life as it was meant
to be lived.”30 Recognizing gender dysphoria as a potential disability under Section 504, he
claimed, “perverted” the statute and constituted a “war on nature,”31 while the proposed rule is
necessary for “stopping the madness and stopping the war.”32 These contemporaneous
statements and actions, coming from the highest ranks of the agency, raise serious questions
regarding the role that animus has played in this proposed rule and the extent to which other
justifications HHS has offered may be pretextual. Such prejudice, furthermore, is precisely the
sort of bias against people with disabilities that Section 504 was in part enacted to address, and
HHS officials’ blatant promotion of this prejudice only underscores why maintaining
nondiscrimination protections for people with gender dysphoria is so critical.
IV.

The alternative of rescinding the 2024 Section 504 Rule in its entirety should be
firmly rejected.

HHS seeks comment on regulatory alternatives it has considered, including the complete
rescission of the Section 504 rule the agency promulgated in 2024. This alternative is not only

29

Id. at 6:25.
Id. at 37:06.
31
Id. at 37:38.
32
Id. at 38:09.
30

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“broader than necessary” to address the application of Section 504 to gender dysphoria. 33 It would
upend a wide array of provisions offering vital and long-overdue clarifications. Rescinding the
entire rule would eliminate numerous updates to prior regulations that were needed to reflect more
than forty years of legal developments, including statutory changes and Supreme Court decisions.
We urge HHS to reject this alternative.
V.

HHS failed to provide sufficient opportunity for comment.

The 30-day comment period is markedly insufficient for a proposed rule of this magnitude and
denies stakeholders the time required to assess and respond to the full scope of its impact. A
standard 60-day comment period is particularly needed given the lasting and wide-ranging harms
the rule may have, its inconsistency with the statute and prior case law, and the cascading effects
it may have even beyond HHS-funded entities. The abbreviated comment period has been eroded
even further by the overlap with holidays, as well as a technical error on Regulations.gov that
barred the submission of comments for a portion of the 30-day period.
VI.

Conclusion

This proposed rule would create unwarranted hardships for people with gender dysphoria, runs
contrary to the intent and rules of construction of Section 504, and deviates from numerous court
decisions that have rejected the reasoning it relies on. We once again urge HHS to withdraw the
rule and instead focus its efforts on strengthening and enforcing the protections of Section 504
for all individuals.
We request that the supporting documentation we have made available through our citations be
considered as part of the formal administrative record for purposes of the Administrative
Procedure Act. If HHS does not intend to consider these materials part of the record as requested,
we ask that you notify us and provide us with an opportunity to submit copies of the studies and
articles into the record. For further information, please contact Ma’ayan Anafi, Senior Counsel for
Health Equity and Justice at the National Women’s Law Center at manafi@nwlc.org.
Abortion Forward
Access Living
Access Ready Inc.
Advance Maryland
Advocates for Trans Equality
AFL-CIO
AIDS United
American Association of People with Disabilities
American Atheists
American Civil Liberties Union
Americans United for Separation of Church and State
Autistic People of Color Fund
Autistic Self Advocacy Network (ASAN)
33

Nondiscrimination on the Basis of Disability in Programs or Activities Receiving Federal Financial
Assistance, 90 Fed. Reg. 59478, 59482 (proposed Dec. 19, 2025) (to be codified at 45 C.F.R. pt. 84).

11
Autistic Women & Nonbinary Network
Bazelon Center for Mental Health Law
California LGBTQ Health and Human Services Network
California Rural Legal Assistance, Inc.
California Women's Law Center
Callen-Lorde Community Health Center
Center for Health Law and Policy Innovation
Center for Law and Social Policy (CLASP)
Center for Medicare Advocacy
Center for Public Representation
Center for Racial & Disability Justice
Center for Reproductive Rights
CenterLink: The Community of LGBTQ Centers
Clearinghouse on Women's Issues
Colorado Center on Law and Policy
Community Catalyst
Council for Global Equality
Deaf Equality
Disability Rights Education and Defense Fund
Diverse Elders Coalition
Doctors for America
ED-OCR Alumni Collective
Epilepsy Foundation of America
Equal Justice Society
Equality California
Equality Illinois
Fair Wisconsin
Family Voices National
Family Voices NJ
Feminist Majority Foundation
Fenway Health
Gender Justice League
GLBTQ Legal Advocates & Defenders (GLAD Law)
Homeless Action Center
Human Rights Defense Center
Human Rights First
Impact Fund
Indivisible Chicago
Institute for Exceptional Care
interACT: Advocates for Intersex Youth
Justice in Aging
Law Foundation of Silicon Valley
Lawyers for Good Government
League of United Latin American Citizens (LULAC)
Legal Aid at Work - Disability & Health Justice Program and Gender Equity & LGBTQ Rights
Program
Legal Council for Health Justice
Little People of America
Massachusetts Law Reform Institute
Mazzoni Center
Movement Advancement Project

12
National Abortion Federation
National Association for Rights Protection and Advocacy
National Center for Law and Economic Justice
National Center for LGBTQ Rights
National Collaborative for Transformative Youth Policy
National Council of Jewish Women
National Disability Rights Network (NDRN)
National Education Association
National Health Law Program
National Latina Institute for Reproductive Justice
National LGBTQ+ Bar Association
National Partnership for Women and Families
National PLACE
National Women’s Law Center
National Women's Political Caucus
NBJC
New Disabled South
Oasis Legal Services
OutCenter Southwest Michigan
PFLAG National
Physicians for Reproductive Health
Planned Parenthood Action Fund
Planned Parenthood Arizona
Positive Women's Network-USA
Public Counsel
Quinnipiac University School of Law Legal Clinic
Reproaction
Reproductive Freedom for All
Reproductive Justice Action Collective
Rocky Mountain Equality
SAGE
Service Employees International Union (SEIU)
Serving at-risk families everywhere, Inc.
SPAN Parent Advocacy Network
State Innovation Exchange (SiX)
The Advocacy Institute
The Center for Constitutional Rights
The Hill Law Firm
The Institute for Health Research & Policy at Whitman-Walker
The LGBTQIA+ Cancer Network
The Partnership for Inclusive Disaster Strategies
The Trevor Project
TransFamily Support Services
Transgender Education Network of Texas (TENT)
Transhealth
Union for Reform Judaism
Uptown People's Law Center
US Gender and Disability Alliance
Western Center on Law & Poverty
Women Enabled International