Two more major hospital systems have agreed to stop providing medical gender-affirming care to transgender minors under settlements with the Trump administration’s Department of Justice.
NYU Langone Health and the University of Pittsburgh Medical Center reached separate agreements with DOJ on September 18, resolving federal investigations into their provision and billing of gender-affirming care.
Under the DOJ settlements, NYU Langone and UPMC agreed to stop providing puberty blockers, gender-affirming hormone therapy and transition-related surgeries to minors.
NYU Langone will pay $8.5 million to the federal government. UPMC will pay $950,000.
Neither hospital admitted wrongdoing.
In fact, the Justice Department’s own announcement says the claims resolved by the agreements are allegations only, that there has been no determination of liability and that both NYU and UPMC expressly denied the allegations.
But the settlements do something much more consequential than collect $9.45 million.
They turn the hospitals’ earlier retreats from transgender youth healthcare into formal agreements with the federal government.
Six Major Hospital Systems Have Now Reached DOJ Agreements
NYU Langone and UPMC are not isolated cases.
According to the Justice Department, similar agreements have already been reached with Mount Sinai Health System, Texas Children’s Hospital, Cleveland Clinic and Connecticut Children’s Hospital.
That makes NYU and UPMC the fifth and sixth major healthcare systems to reach agreements with DOJ ending or restricting medical gender-affirming care for minors.
The department says its nationwide investigation is examining potential violations of the False Claims Act, Food, Drug and Cosmetic Act and other federal healthcare laws.
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DOJ has specifically alleged that some providers may have used improper diagnosis codes or billing practices to obtain payment from federal healthcare programs or private insurers for gender-affirming care.
Those remain allegations.
No court found NYU Langone or UPMC liable for healthcare fraud as part of these settlements.
Both hospitals denied the government’s allegations.
DOJ nevertheless made clear that the broader campaign is continuing.
Assistant Attorney General Brett Shumate said investigations into other healthcare providers remain underway and threatened prosecution against providers the department believes violated federal law.
These Hospitals Had Already Stopped Providing Care
The immediate effect on appointments may be more limited than the announcement initially suggests.
Both healthcare systems had already stopped or substantially curtailed medical gender-affirming care for young transgender patients.
UPMC stopped providing gender-affirming medical care to patients under 19 in 2025.
NYU Langone had also discontinued medical treatment through its transgender youth program earlier in 2026 amid escalating federal pressure on hospitals providing gender-affirming care.
The September 18 settlements formalize those decisions.
That distinction matters.
A hospital can potentially reverse an internal policy.
A settlement with the United States government creates legal obligations that are considerably harder to walk away from.
For UPMC, the restriction is particularly significant.
WESA reports that UPMC agreed to a 10-year moratorium on providing gender-affirming medical care to transgender patients under 19.
The complete settlement agreements have not been made public, leaving some of their terms and enforcement mechanisms unknown.
But the larger pattern is becoming increasingly visible: federal investigations are helping transform hospital-by-hospital withdrawals from transgender youth healthcare into longer-term commitments.
DOJ Also Wanted Transgender Patients’ Medical Records
The story is not only about access to healthcare.
It is also about medical privacy.
Federal investigators sought information about transgender minors who received gender-affirming care from both healthcare systems.
NYU Langone disclosed in May that it received a federal grand jury subpoena from the U.S. Attorney’s Office for the Northern District of Texas.
The subpoena sought information concerning patients under 18 who received gender-affirming care at NYU Langone between 2020 and 2026.
It also sought the names of healthcare providers and others involved in providing that care.
The demand eventually ran into a federal court.
On July 6, a federal judge issued a preliminary injunction preventing NYU Langone from disclosing identifying or sensitive health information about those minor patients.
The injunction also prohibited DOJ from seeking, receiving, using or retaining that information.
NYU Langone says it never produced patient information or medical records in response to the subpoena.
The September settlement resolves that fight.
According to NYU Langone, DOJ has now agreed to end its investigations and remove the threat that the hospital would be required to provide the confidential patient information previously demanded.
UPMC Won Its Patient-Records Fight Too
UPMC faced a similar battle over the medical records of transgender patients.
DOJ sought records involving young people who received gender-affirming care through UPMC Children’s Hospital of Pittsburgh.
A federal judge rejected the government’s subpoena.
When DOJ proposed accepting anonymized records instead, U.S. District Judge Cathy Bissoon rejected that proposal as well, finding that effective anonymization could not be assured given the scope of the government’s request.
The Justice Department appealed before abandoning that effort in August.
That sequence is important.
DOJ did not have to win its patient-records fight to ultimately secure a settlement restricting the care itself.
The department lost its effort to obtain those UPMC records, dropped its appeal and then reached an agreement under which UPMC will refrain from providing gender-affirming medical care to patients under 19 for a decade.
NYU Will Continue Mental Healthcare for Transgender Youth
The NYU settlement does not eliminate every gender-affirming service available to transgender young people.
NYU Langone says its pediatric mental-health programs will continue.
The settlement also does not affect gender-affirming healthcare provided to adults 18 and older.
That creates a clear age boundary.
An adult transgender patient can continue receiving medical gender-affirming care through NYU Langone.
A transgender minor cannot receive the puberty blockers, hormone therapy or transition-related surgery covered by the DOJ agreement.
Why the NYU Settlement Matters in New Jersey
The NYU Langone settlement has particular significance for New Jersey.
NYU Langone is not simply a distant New York hospital system. It operates healthcare facilities in New Jersey, including child mental-health services in Hackensack.
New Jersey, meanwhile, has moved in the opposite direction from the federal government.
In August, Gov. Mikie Sherrill signed legislation explicitly expanding New Jersey’s healthcare shield protections to gender-affirming care.
Those protections include restrictions on releasing patient information and limits on state cooperation with certain outside investigations targeting care legally provided in New Jersey.
New Jersey also maintains protections intended to preserve access to gender-affirming healthcare for residents and people traveling into the state for care.
But state protections have limits.
New Jersey can protect healthcare that remains available within New Jersey.
It cannot force a healthcare system to provide a service that the system has agreed with the federal government not to provide.
That makes the shrinking number of major healthcare systems offering pediatric gender-affirming medical care important even in states where the treatment remains protected by state law.
Legal protection does not guarantee practical access.
Allegations Are Not Findings of Fraud
That distinction is especially important when reading the Justice Department’s announcement.
DOJ uses highly charged language to describe gender-affirming care and presents its investigation as an effort to uncover fraud and violations of federal healthcare law.
But the department’s own announcement contains an important qualification:
The claims resolved by these agreements are allegations.
There has been no determination of liability.
NYU Langone and UPMC both deny wrongdoing.
That means these settlements should not be described as proof that either hospital committed healthcare fraud.
What they establish is that two major healthcare systems decided to settle federal investigations, make payments to the government and accept restrictions on medical gender-affirming care rather than continue fighting the Justice Department.
Trans-Youth Care Is Shrinking One Hospital at a Time
Congress has not enacted a nationwide law banning every hospital from providing gender-affirming medical care to transgender minors.
Yet access continues to shrink.
At least six major hospital systems have now reached agreements with the Justice Department restricting or ending this care.
Others have independently reduced or eliminated services amid federal investigations, funding threats and regulatory uncertainty.
That creates a healthcare landscape where gender-affirming care can remain technically legal in a state while becoming increasingly difficult to obtain.
For a transgender young person who loses access to their healthcare provider, the mechanism behind the loss may make little practical difference.
The law may say the care is protected.
But if the hospital has stopped providing it, the appointment is still gone.
And with each new DOJ settlement, another part of the already shrinking network of medical care available to transgender young people becomes harder to rebuild.
Read More
- HHS Turns Anti-Trans Report Into Federal Referral List for DOJ Investigations
- Mount Sinai Abandons Its Young Trans Patients, Agrees to End Gender-Affirming Care
- DOJ Forces Third Children’s Hospital to End Trans Youth Care as Federal Pressure Campaign Expands
- New Jersey Is Back in the Fight, Challenging Trump Medicaid Ban on Trans-Youth Care