White House
Expanded global gag rule to ban US foreign aid to groups that promote ‘gender ideology’
Activists, officials say new regulation will limit access to gender-affirming care
The Trump-Vance administration has announced it will expand the global gag rule to ban U.S. foreign aid for groups that promote “gender ideology.”
Deputy Secretary of State Christopher Landau in a memo, titled Combating Gender Ideology in Foreign Assistance, the Federal Register published on Jan. 27 notes “previous administrations … used” U.S. foreign assistance “to fund the denial of the biological reality of sex, promoting a radical ideology that permits men to self-identify as women, indoctrinate children with radical gender ideology, and allow men to gain access to intimate single-sex spaces and activities designed for women.”
“Efforts to eradicate the biological reality of sex fundamentally attack women by depriving them of their dignity, safety, and well-being. It also threatens the wellbeing of children by encouraging them to undergo life-altering surgical and chemical interventions that carry serious risks of lifelong harms like infertility,” reads the memo. “The erasure of sex in language and policy has a corrosive impact not just on women and children but, as an attack on truth and human nature, it harms every nation. It is the purpose of this rule to prohibit the use of foreign assistance to support radical gender ideology, including by ending support for international organizations and multilateral organizations that pressure nations to embrace radical gender ideology, or otherwise promote gender ideology.”
President Donald Trump on Jan. 28, 2025, issued an executive order — Protecting Children from Chemical and Surgical Mutilation — that banned federal funding for gender-affirming care for minors.
President Ronald Reagan in 1985 implemented the global gag rule, also known as the “Mexico City” policy, which bans U.S. foreign aid for groups that support abortion and/or offer abortion-related services.
Trump reinstated the rule during his first administration. The White House this week expanded the ban to include groups that support gender-affirming care and diversity, equity, and inclusion programs.
The expanded global gag rule will take effect on Feb. 26.
“None of the funds made available by this act or any other Act may be made available in contravention of Executive Order 14187, relating to Protecting Children From Chemical and Surgical Mutilation, or shall be used or transferred to another federal agency, board, or commission to fund any domestic or international non-governmental organization or any other program, organization, or association coordinated or operated by such non-governmental organization that either offers counseling regarding sex change surgeries, promotes sex change surgeries for any reason as an option, conducts or subsidizes sex change surgeries, promotes the use of medications or other substances to halt the onset of puberty or sexual development of minors, or otherwise promotes transgenderism,” wrote Landau in his memo.
Landau wrote the State Department “does not believe taxpayer dollars should support sex-rejecting procedures, directly or indirectly for individuals of any age.”
“A person’s body (including its organs, organ systems, and processes natural to human development like puberty) are either healthy or unhealthy based on whether they are operating according to their biological functions,” reads his memo. “Organs or organ systems do not become unhealthy simply because the individual may experience psychological distress relating to his or her sexed body. For this reason, removing a patient’s breasts as a treatment for breast cancer is fundamentally different from performing the same procedure solely to alleviate mental distress arising from gender dysphoria. The former procedure aims to restore bodily health and to remove cancerous tissue. In contrast, removing healthy breasts or interrupting normally occurring puberty to ‘affirm’ one’s ‘gender identity’ involves the intentional destruction of healthy biological functions.”
Landau added there “is also lack of clarity about what sex-rejecting procedures’ fundamental aims are, unlike the broad consensus about the purpose of medical treatments for conditions like appendicitis, diabetes, or severe depression.”
“These procedures lack strong evidentiary foundations, and our understanding of long-term health impacts is limited and needs to be better understood,” he wrote. “Imposing restrictions, as this rule proposes, on sex-rejecting procedures for individuals of any age is necessary for the (State) Department to protect taxpayer dollars from abuse in support of radical ideological aims.”
Landau added the State Department “has determined that applying this rule to non-military foreign assistance broadly is necessary to ensure that its foreign assistance programs do not support foreign NGOs and IOs (international organizations) that promote gender ideology, and U.S. NGOs that provide sex-rejecting procedures, and to ensure the integrity of programs such as humanitarian assistance, gender-related programs, and more, do not promote gender ideology.”
“This rule will also allow for more foreign assistance funds to support organizations that promote biological truth in their foreign assistance programs and help the (State) Department to establish new partnerships,” he wrote.
The full memo can be found here.
Council for Global Equality Senior Policy Fellow Beirne Roose-Snyder on Wednesday said the expansion of the so-called global gag rule will “absolutely impact HIV services where we know we need to target services, to that there are non-stigmatizing, safe spaces for people to talk through all of their medical needs, and being trans is really important to be able to disclose to your health care provider so that you can get ARVs, so you can get PrEP in the right ways.” Roose-Snyder added the expanded ban will also impact access to gender-affirming health care, food assistance programs and humanitarian aid around the world.
“This rule is not about gender-affirming care at all,” she said during a virtual press conference the Universal Access Project organized.
“It is about really saying that if you want to take U.S. funds — and it’s certainly not about gender-affirming care for children — it is if you want to take U.S. funds, you cannot have programs or materials or offer counseling or referrals to people who may be struggling with their gender identity,” added Roose-Snyder. “You cannot advocate to maintain your country’s own nondiscrimination laws around gender identity. It is the first place that we’ve ever seen the U.S. government define gender-affirming care, except they call it something a lot different than that.”
The Congressional Equality Caucus, the Democratic Women’s Caucus, the Congressional Hispanic Caucus, the Congressional Asian and Pacific American Caucus, and the Congressional Black Caucus also condemned the global gag rule’s expansion.
“We strongly condemn this weaponization of U.S. foreign assistance to undermine human rights and global health,” said the caucuses in a statement. “We will not rest until we ensure that our foreign aid dollars can never be used as a weapon against women, people of color, or LGBTQI+ people ever again.”
White House
Trump-Vance administration’s LGBTQ brain drain: what you need to know
Several high profile figures have left government since January 2025
Uncloseted Media published this article on Aug. 21.
By SPENCER MACNAUGHTON and HOPE PISONI | Since President Donald Trump regained office in January 2025, he and his administration have waged an all-out war against the LGBTQ community.
This has led queer Americans to move to other countries at unprecedented rates — Rainbow Railroad, a Canadian nonprofit that supports LGBTQ asylum seekers, reported receiving a huge increase in inquiries from the U.S. last year.
The same pattern is playing out within the government. And it’s leading to a brain drain of competent queer employees and allies who are either resigning or being fired, often because of their LGBTQ identity or their belief that queer people deserve basic human rights.
Here are six examples of federal workers who had a messy exit from Trump 2.0:
Demetre Daskalakis
- WHAT HE DID: Dr. Daskalakis is one of the foremost LGBTQ health professionals in the U.S. Under Trump’s first term, he was appointed director of the Division of HIV/AIDS Prevention at the Centers for Disease Control and Prevention. Under Biden, he also served as the deputy response coordinator for mpox at the White House.
- WHAT HAPPENED: While he continued a lot of this work under Trump 2.0, he didn’t last long. In August 2025, he resigned from the CDC, writing in his resignation letter that he was “unable to serve in an environment that treats CDC as a tool to generate policies and materials that do not reflect scientific reality and are designed to hurt rather than to improve the public’s health.”
- BOTTOM LINE: I recently interviewed Daskalakis, where he told me that leadership from RFK Jr.’s Health and Human Services Department justified HIV cuts by saying the virus is “just too woke.”
Julia Curlee
- WHAT SHE DID: Julia Curlee worked in intelligence for nearly two decades between the CIA and the National Security Council. Earlier this week, she wrote an article in The Atlantic explaining how she had served as Mike Pence’s daily briefer and the NSC’s director for intelligence programs. During Trump 1.0, she briefed the president on Air Force One.
- WHAT HAPPENED: Curlee told CNN this week that in Trump’s second term, her treatment by the federal government transformed. She was no longer allowed to use the women’s bathroom on federal property and had to leave her workplace to relieve herself. Her passport was also reissued to read “male,” which led to complications when traveling abroad. In March 2025, less than 70 days into Trump’s second term, Curlee says she received a call while at a rib joint in Virginia with her family informing her that her White House tour was over and that they couldn’t tell her why. She continued to work for the CIA for some months, but she later resigned.
- BOTTOM LINE: Curlee wrote that moments after she learned she was fired from the White House, she saw a post from right-wing political activist Laura Loomer that read “A transgender, Biden holdover who hates President Trump is still working in the NSC intel office. I’m told there are several NSC staffers who have complained that this trans Biden holdover hasn’t been fired yet, but nothing is being done about it.”
Marc Seawright
- WHAT HE DID: Marc Seawright worked for more than eight years at the U.S. Equal Employment Opportunity Commission. Most recently, he served as the EEOC’s director of information governance and strategy, where he oversaw tech policy to help combat workplace harassment and discrimination.
- WHAT HAPPENED: During Trump 2.0, Seawright was ordered to develop technology that would erase any mention of LGBTQ identities from EEOC outreach materials. “[My expertise] was being leveraged to perpetuate discrimination against people like me,” he told the Associated Press. In that article, Seawright and other transgender and gender nonconforming federal employees described their “fear, grief, frustration, and distress working for the federal government at a time when it rejects them — often with no clear path for recourse or support.”
- BOTTOM LINE: Seawright quit in June, citing a hostile work environment. “It became overwhelming. It felt insurmountable,” he told the AP. He has now hired lawyers at Katz Banks Kumin and has filed a discrimination complaint.
David Maltinsky
- WHAT HE DID: Until 2025, Maltinsky worked for more than 16 years at the FBI as an intelligence specialist. In 2025, he was training to become a special agent, but three weeks ahead of graduation, he was fired.
- WHAT HAPPENED: On Oct. 1, he was delivered a letter from FBI Director Kash Patel informing him that he was being fired for an “inappropriate display of political signage.” The signage in question, according to Maltinsky, was a Pride flag displayed in his work station at a previous post in Los Angeles. The flag had been given to him by the FBI’s LA Field Office, and Maltinsky says he had been told by multiple supervisors that displaying it would not be a violation.
- BOTTOM LINE: Maltinsky is currently suing the FBI and the Department of Justice, arguing that his firing constituted unlawful discrimination.
Mary Brinkmeyer
- WHAT SHE DID: Brinkmeyer had been working as a psychologist for the Department of Veterans Affairs since 2008. She held multiple leadership roles, including the LGBTQ veteran care coordinator at the Hampton VA Medical Center. She established the first military support group for trans servicemembers and was awarded Navy Psychology Civilian Psychologist of the Year in 2016.
- WHAT HAPPENED: Following an early Trump executive order directing the federal government to purge any practices promoting “gender ideology,” Brinkmeyer says staff at her workplace were told to remove all LGBTQ-affirming materials from both public and private areas, as well as to identify “anything in medical records, training materials, or patient resources that could be considered ‘gender ideology.’” When she refused to comply and confronted her supervisor, she says her concerns were dismissed.
- BOTTOM LINE: Brinkmeyer resigned in February 2025, stating that she “didn’t want to be complicit in something that I knew was wrong.”
Amy Paris
- WHAT SHE DID: Paris was the second-highest ranking trans woman in the federal government, serving as a deputy digital services lead in the HHS Department, where she oversaw the safety of organ donations. Prior to that, she worked in a number of tech-related roles across the federal government since the Bush administration. She helped create cross-agency spending trackers, streamlined unemployment insurance during the pandemic and implemented trans-inclusive policies like gender-neutral passports.
- WHAT HAPPENED: Paris was fired as part of a string of mass layoffs across the federal government in February 2025. While the HHS did not publicly comment on why she was fired, Paris says she was told it was because of her performance, despite the fact that she got a 4.75 out of five on her last performance review and was praised for her work by multiple Biden administration officials.
- BOTTOM LINE: Paris told the 19th she suspected her firing was politically motivated, saying the Trump administration is “trying to sow discord and disrupt confidence in the workings of the federal government.”
White House
White House targets gender-affirming care funding, states fight back
Attorneys general from Md. and elsewhere are fighting directives
The Centers for Medicare and Medicaid Services announced last week that federal funding could no longer be used to pay for gender-affirming care through Medicaid or the Children’s Health Insurance Program.
The rule prohibits federal Medicaid dollars from covering puberty blockers, hormone therapy, and rare instances of surgery for enrollees under the age of 18 in the Medicaid program and under the age of 19 in CHIP. It does not prohibit coverage of counseling or psychotherapy as part of gender-affirming care.
The decision to restrict what healthcare is covered by federal dollars is part of a longer, more aggressive stance the Trump-Vance administration is taking toward LGBTQ healthcare.
Since taking the White House back for his second term, Trump has signed three executive orders that directly target transgender Americans. They include Executive Order 14168, “Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government” that requires the federal government to recognize only a person’s sex at birth, not their gender identity; Executive Order 14183, “Prioritizing Military Excellence and Readiness,” which attempts to remove transgender service members from the military and prevent them from enrolling; and an executive order that helped spur this change by restricting gender-affirming care.
The administration’s choice to villainize gender-affirming care, despite it being considered a best medical practice recommended by nearly every major medical group for gender dysphoria or gender incongruence, including the American Medical Association, American Academy of Pediatrics, and American Psychological Association, comes as KFF, a source for health policy research and polling data, estimates about 130,000 young trans people with Medicaid or CHIP coverage could be impacted by the policy.
“Today, we are ending federal taxpayer funding for sex-rejecting procedures on children,” U.S. Department of Health and Human Services Secretary Robert F. Kennedy, Jr., said last week when announcing the change. “These interventions carry serious risks and can cause irreversible harm. The federal government will no longer use Medicaid and CHIP dollars to fund procedures that fail to meet the evidentiary standard our children deserve.”
“Children deserve our protection, not experimental interventions that pose serious risks and convey no proven benefits,” said CMS Administrator Mehmet Oz. “By cutting off federal funds for these sex-rejecting procedures, we’re following the science, saving taxpayer dollars, and, most importantly, protecting children from potentially irreversible harm so they can truly flourish.”
The administration’s push is having a chilling effect on state healthcare legislation — more states now prohibit gender-affirming care than ever before. States with gender-affirming care restrictions jumped from four in 2023 to 27 states today.
The funding change has been met with fierce pushback from LGBTQ advocates, health experts, and government officials across the country before the rule goes into effect.
Some of the first actions against this policy began in July 2025.
Twenty-one states have attempted to restrict this effort in some fashion from going through as the White House intends. They include Arizona, California, Colorado, Connecticut, Delaware, Illinois, Maryland, Massachusetts, Maine, Michigan, Minnesota, Nevada, New Mexico, New Jersey, New York, Oregon, Rhode Island, Vermont, Washington, and Wisconsin, as well as Pennsylvania Gov. Josh Shapiro on behalf of his state.
The coalition of attorneys general filed lawsuits challenging nine separate provisions of the final rule, arguing that they would make it harder for consumers to get coverage through the ACA, increase costs for states, and weaken key ACA protections.
The U.S. District Court for the District of Massachusetts on Aug. 15 struck down a key provision of a Trump-Vance administration final rule that would have excluded coverage of certain types of gender-affirming care as essential health benefits under the Affordable Care Act. Essential health benefits are subject to the ACA’s financial protections, including limits on out-of-pocket costs.
“Everyone deserves access to health coverage,” said California Attorney General Rob Bonta. “The Trump administration tried to exclude gender-affirming care from qualifying as an essential health benefit. We fought back, and the court’s ruling means this care can — and in many states must — qualify for the ACA’s financial protections, ensuring transgender people have an equal opportunity to benefit from the ACA.”
“The Trump administration tried to make essential care unaffordable for transgender Marylanders by stripping it out of the ACA’s cost protections,” said Maryland Attorney General Anthony Brown. “We fought to keep that care covered, and we won. My Office will always defend Marylanders’ right to the care they need.”
The final rule at issue — the “Marketplace Integrity and Affordability” rule — was proposed by the Trump-Vance administration in March 2025, purportedly to “curb ACA enrollment fraud” and reduce federal spending on subsidies that help consumers afford ACA coverage. Among other changes, the rule would have removed certain types of gender-affirming care from the ACA’s 10 essential health benefit categories.
“This president would rather target young people than lower costs or expand access to health care. It is reprehensible that our federal government is intent on hurting and isolating the adolescents it is supposed to protect. I will use every tool at my disposal to fight this proposal and protect transgender Americans and their families,” said New York Attorney General Letitia James in December after the policy was announced.
In addition to state government resistance to the change, multiple LGBTQ advocates have committed to protecting the right to healthcare for LGBTQ children.
Rocky Mountain Equality CEO Mardi Moore affirmed those in Colorado would continue to help people most at risk if the change goes through.
“First, to the families impacted by this news: you will not be cut off immediately. The rule takes effect Oct. 13, 2026, and providers can continue to bill Medicaid and CHIP for youth already receiving gender-affirming care for up to six months after that. Rocky Mountain Equality is here, and we can help you understand your options to continue your child’s care.
“This is discrimination dressed up as rule-making. Government healthcare policy should expand what people can access, not strip away care that families and doctors have already determined is medically necessary,” Moore added. “We’ve seen this pattern before with other kinds of essential care, and it rarely stops with just one restriction. Any effort to ban or limit care opens the door for more restrictions on more kinds of care.”
The Human Rights Campaign, the largest LGBTQ lobbying group in the U.S., issued multiple statements following the announcement, and has filed a similar lawsuit against the federal government for prohibiting gender-affirming care to federal employees using federal health plans.
HRC President Kelley Robinson said taking a hard stance against what the administration is presenting as a win for the American people that will ultimately restrict healthcare options for thousands of Americans.
“Every young person is entitled to the health care that they, their parents, and their medical providers agree that they need, without politicians interfering with these important and highly personal decisions. And yet, rather than working to make healthcare more affordable and accessible, the Trump administration continues to obsess over the healthcare needs of trans youth, this time by cutting off health insurance coverage for those who rely on Medicaid and CHIP to access that care,” Robinson said. “The Trump administration is terrorizing trans youth and their families with these kinds of actions, and it has to stop.”
White House
HRC files class action over federal ban on gender-affirming care coverage
Lawsuit filed Monday challenges White House effort to restrict care
The Human Rights Campaign Foundation, the nonprofit sister organization to the largest LGBTQ human rights lobbying and advocacy organization in the U.S., along with law firms Correia & Puth and Cohen Milstein Sellers & Toll, filed a class action lawsuit against the government as it attempts to restrict gender-affirming healthcare for federal employees.
The suit, filed on Monday, alleges that the Office of Personnel Management, run by Trump appointee Scott Kupor, is discriminating against LGBTQ federal employees (and their families and retired employees) by prohibiting health insurance coverage for gender-affirming care under the Federal Employees Health Benefits and Postal Service Health Benefits plans. There are five plaintiffs named in the complaint, but it extends to others who have those healthcare plans.
The document asserts that OPM’s prohibition on coverage for “gender transition” care in the FEHB and PSHB programs violates Title VII, the federal law that prohibits discrimination based on sex, race, color, religion, or national origin.
The policy, which was implemented on Jan. 1 following the 2025 issuing of Program Carrier Letter, mandated that insurance providers in these programs deny any coverage for gender-affirming care. In February, HRC filed a federal complaint with OPM over the change in healthcare policy, which was ultimately passed to the Equal Employment Opportunity Commission for review. That complaint is now an officially filed class action lawsuit in the U.S. District Court for the District of Columbia.
Research from the Williams Institute at UCLA Law, a think tank that collects data and conducts research on issues related to sexual orientation and gender identity, indicates that this policy denying gender-affirming care will impact healthcare access for at least 39,400 current and former federal employees and their dependents.
Human Rights Campaign President Kelley Robinson released a statement following the lawsuit’s filing.
“Our message to the Trump administration is simple: we’ll see you in court,” said Robinson. “Healthcare access should never be weaponized to advance discrimination — and the denial of coverage for critical healthcare based simply on who you are blatantly violates the rights of all of us.”
Gender-affirming care has been under constant attack by the Trump-Vance administration since its return to the White House, despite the practice being considered as extensively evidence-based but also supported by nearly every major medical organization. This type of care is provided to all people—not just transgender people—and includes things such as social affirmation, including using correct names and pronouns and wearing clothing that matches a person’s gender identity; mental health support, such as counseling to reduce depression and anxiety; and, in some cases, medical interventions such as reversible puberty blockers or hormone therapy when deemed medically appropriate.
“Federal employees have been through the wringer with the Trump administration,” said Cathy Harris, partner at Correia & Puth. “We draw the line at blatant discrimination to deny healthcare to our nation’s dedicated civil servants.”
“This odious policy is the latest example of the Trump administration’s obsession with targeting transgender people, using shameful and cruel tactics to threaten their employment, their health, and the well-being of themselves and their families,” Robinson added. “OPM’s actions will not go unchallenged, and we’ll continue to fight so that federal employees and their families receive the dignity they deserve.”
This is not the first time the White House has directly attacked gender-affirming care.
In January 2025, the administration issued Executive Order 14187, titled “Protecting Children from Chemical and Surgical Mutilation.” The order directs federal agencies to restrict gender-affirming medical care — including puberty blockers, hormone therapy, and surgeries — for individuals under the age of 19.
For more information on how to get involved with the lawsuit, visit hrc.org.
