We are committed to supporting trans lives, rights, and dignity. Our rights are stronger when they cover all of us.
On Friday, October 30, 2026, the U.S. Department of Health and Human Services (HHS) issued a final rule that says gender dysphoria ‘not resulting from physical impairments’ is not a disability under Section 504 of the Rehabilitation Act. Disability Rights Education and Defense Fund (DREDF) strongly condemns this stance.
The rule declares that gender dysphoria “not resulting from physical impairments” is not a disability under Section 504 of the Rehabilitation Act, the federal law that bars disability discrimination by programs that receive federal money. It applies to every hospital, clinic, health plan, child welfare agency, and human services program that receives HHS funding, and it invites those programs to turn people away.
HHS calls this a “clarification.” It is not. It takes civil rights protections away from transgender people.
When HHS proposed this rule in December, DREDF joined 148 other disability, LGBTQI+, health, and civil rights organizations in asking HHS to drop it. HHS went ahead with the harmful revision anyway. Our objections still remain:
Gender Dysphoria is not “Gender Identity Disorder.” Section 504 excludes “gender identity disorders not resulting from physical impairments,” an outdated diagnosis that treated being transgender as the problem. Gender dysphoria is a separate diagnosis for serious distress that interferes with a person’s daily life. The U.S. Court of Appeals for the Fourth Circuit recognized this in Williams v. Kincaid (2022), and the Supreme Court let that ruling stand.
- Most courts agree. Since 2013, when gender dysphoria entered the Diagnostic and Statistical Manual of Mental Disorders (DSM) — the main diagnostic manual used by U.S. clinicians to diagnose and treat mental disorders — 26 of 31 court decisions on the question have held that it is not automatically excluded from Section 504 or the Americans with Disabilities Act (ADA). Every court to decide the issue since Williams has reached that conclusion.
- Congress told agencies to read disability broadly. In the ADA Amendments Act of 2008, Congress directed that the definition of disability be read “in favor of broad coverage.” So exceptions should be read narrowly, not stretched to cover new groups of people.
An agency rule cannot change a law passed by Congress. Section 504 itself has not changed, and HHS-funded programs that discriminate against people with disabling gender dysphoria can still be held legally responsible. Far from “restoring clarity,” this rule will confuse providers and lead to more discrimination.
The harm is real and immediate. Under this rule, people with gender dysphoria could be refused medical care, including care that has nothing to do with gender dysphoria. Parents, foster parents, and young people could face exclusion in foster care and other child welfare programs. Families could be shut out of programs like Head Start and services for older adults. Intersex people may be forced to prove details about their bodies to get the accommodations they need.
Transgender people already face widespread mistreatment in health care. In the Health and Wellbeing Report of the 2022 U.S. Transgender Survey, 47% of respondents reported a negative experience with a health provider in the previous year because they were transgender. Among transgender respondents with disabilities, that figure rose to 58%. Disabled trans people are directly harmed by this rule.
HHS claims this rule protects people with disabilities and the integrity of disability rights law. DREDF rejects that claim. Excluding some disabled people from protection does not make the rest of us safer. It weakens the law for everyone. The breadth and diversity of the disability community has always been its strength, and we have spent decades fighting the idea that civil rights belong only to some of us. Congress rejected that idea when it passed the ADA Amendments Act in 2008. We reject it now.
We also cannot ignore what HHS leaders said when they announced this rule. Senior officials described recognizing transgender people as a “war on nature.” That is hostility toward a group of people, and it is exactly the kind of prejudice Section 504 was written to stop.
Our movement knows what solidarity makes possible. In 1977, disabled activists occupied the San Francisco offices of the Department of Health, Education, and Welfare, the agency that became HHS, for nearly four weeks until the government signed the first Section 504 regulations. They held on because others showed up. The Black Panther Party brought hot meals every day. Glide Memorial Church, labor unions, and community groups sent supplies. Members of the Butterfly Brigade, a gay community patrol, smuggled in walkie-talkies so protesters could communicate. Section 504 was won through cross-movement solidarity. Nearly fifty years later, we will not be turned against our trans community members and allies.
“This rule is not about clarity. It is about exclusion,” said Michelle Uzeta, Executive Director of DREDF. “Disability rights were won by a coalition of people who refused to leave anyone behind. Transgender people, including disabled trans people, are part of our community. An attack on their civil rights is an attack on ours, and we will fight together to defend all of us.”
Anyone who faces discrimination in an HHS-funded program should know that the law and your worth has not changed. Document what happened. Check the Advocates for Trans Equality Legal Assistance Inquiries and Trans Legal Services Network to find a legal advocate and additional resources, including the Trans Rights Survival Guide. Email DREDF at info@dredf.org to share your story to be used in our advocacy as we meet with officials in Washington, DC, and in California. Above all, know that you are not alone. DREDF will continue working with our partners across the disability, LGBTQ+, and civil rights movements to challenge this rule, to enforce Section 504 as Congress wrote it, and to protect every disabled person’s right to equal access to health care and human services.
