Yesterday, Disability Rights California submitted public comment in strong opposition to RIN 0945-AA27, “Nondiscrimination on the Basis of Disability in Programs or Activities Receiving Federal Financial Assistance.” As California’s Protection and Advocacy Organization, DRC’s job is to protect and expand disability rights. The proposed rule does the opposite: it limits the scope of Section 504’s essential civil rights protections. 

The federal government is attempting to position transgender rights and disability rights in opposition to each other. This message is hateful and wrong. Disability rights and transgender rights complement and strengthen each other, especially for the many people who identify as both trans and disabled. 

Section 504 exists to protect people with disabilities from discrimination in programs and services that receive federal financial assistance. Transgender people with gender dysphoria can rely on those legal rights when they seek medically necessary care, behavioral health supports, crisis services, substance use treatment, and hospital care in systems funded with federal dollars. 

The Department of Health and Human Services (HHS) proposed to single out gender dysphoria for exclusion under Section 504 by adding language to 45 C.F.R. § 84.4(g). If finalized, it will send a clear message to providers, contractors, and payers: it is acceptable to treat transgender people as less protected. In practice, the proposed rule would increase the risk of denial, delay, and mistreatment in the exact settings Section 504 is meant to provide protections for: health care and human services programs receiving federal financial assistance. 

No one should be turned away from care or pushed into harm because of who they are. Transgender people deserve the same equity, dignity, and legal protection as everyone else when they walk into a clinic, an emergency room, a crisis program, or a hospital. 

Disability Rights California urges HHS to withdraw the proposed amendment to 45 C.F.R. § 84.4(g) that would treat “gender dysphoria not resulting from physical impairments” as categorically excluded under Section 504. Section 504 should do what it was designed to do: protect people from discrimination in federally funded systems, not be used as a partisan effort to target transgender people who need care and equal treatment. 

Public Comment

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

Disability Rights California (DRC) is the federally designated Protection and Advocacy System for the State of California. As the largest disability rights organization in the country, we serve thousands of people with disabilities each year and work to protect and advocate on behalf of such individuals, including by monitoring the implementation of Section 504 of the Rehabilitation Act of 1973. Among the thousands of people with disabilities who we serve are people with a gender dysphoria diagnosis.1

Disability Rights California opposes the proposed rule to exclude gender dysphoria from the protection of Section 504 of the Rehabilitation Act. 

The proposed rule to change Section 504, contained in RIN 0945-AA27, would limit disability rights and potentially subject thousands of people to discrimination, particularly people who are both transgender and disabled. Section 504 should do what it was designed to do: protect people from discrimination in federally funded systems, not be used to target transgender people who need care and equal treatment.

Congress intended the definition of disability in Section 504 to be construed broadly and to include people with gender dysphoria.

Congress intended Section 504 to broadly protect people with disabilities from discrimination by the federal government or recipients of federal financial assistance. Section 504 is meant to protect any individual with a physical or mental impairment that substantially limits one or more major life activities. And so, when an individual experiences significant distress that limits their ability to work, learn, or care for themselves, they meet the statutory definition of "individual with a disability." Congress made clear in the preamble to the 2024 Final Rule that “an individual with gender dysphoria may have a disability under section 504.” By stripping protections away from those with gender dysphoria, HHS is reinforcing the very stigma that Section 504 was enacted to eliminate.

Accepted medical evidence, legislative intent, and existing case law support interpreting gender dysphoria as protected by Section 504.

Gender dysphoria is an established medical diagnosis that is distinct from the terms "gender identity disorders" used half a century ago. As the Fourth Circuit explained in Williams v. Kincaid, the evolution of sound medical research must be the basis of legal definition. The rights system in the U.S. can no longer rely on outdated terminology to justify the wholesale exclusion of a vulnerable group of people. To "carve out" gender dysphoria today is to ignore decades of clinical progress in favor of maintaining a discriminatory status quo.

This proposal is steeped in anti-transgender animus, which is an unconstitutional basis for excluding people from civil rights protections.

Though not all transgender people experience gender dysphoria, gender dysphoria is prevalent among the transgender community. In addition, psychological distress associated gender dysphoria can be exacerbated due to societal discrimination, dehumanization, and institutionalization of individuals who do not comply with societal gender norms. The framing of this rule from HHS, particularly in packaging the proposed rule with restrictions on gender-affirming care, shows intent to use this proposed rule to discriminate against transgender people.

If a transgender individual does identify with experiencing gender dysphoria, there is no valid reason to subvert chosen doctor-patient relationships and deny access to essential care and disability protections. Much like the dispute in Williams v. Kincaid, this rule is a clear violation of equal protection rights as it specifically aims to deprive transgender individuals experiencing gender dysphoria from vital disability protections. It is fully devoid of a legitimate government interest and should not be allowed to stand.

The proposed rule would impede access to HHS-funded programs for people with gender dysphoria and enable government-sanctioned discrimination.

People with gender dysphoria already experience barriers to health care, and the proposed rule would exacerbate these barriers by stripping the protections of Section 504. The proposed rule could limit access to essential health and human services, including both basic health care and life-saving gender-affirming care. The Ninth Circuit has pointed out that “[f]ailure to follow an appropriate treatment plan [for gender dysphoria] can expose transgender individuals to a serious risk of psychological and physical harm.” Williams v. Kincaid, 45 F.4th 759, 768 (4th Cir. 2022), (quoting Edmo v. Corizon, Inc., 935 F.3d 757, 771 (9th Cir. 2019)). Accordingly, this proposed rule could endanger the lives of people with gender dysphoria.

For example, a person with a disability shared:

• Gender-affirming care was lifesaving for me. I had lived with gender dysphoria for as long as I can remember, and it affected all aspects of my life. Before I could transition, it was physical, emotional, and constant, showing up as: a pit in my stomach, a lump in my throat, deep depression and anxiety, and the daily strain of being seen and addressed in a way that did not match who I really am. It added an additional layer of difficulty to function at school and work, at home, and in public. For me, gender dysphoria was disabling. Not every trans person experiences dysphoria, but no one should be turned away, delayed, or mistreated in federally funded health care, or written out of disability civil rights protections, because they are trans or because they have gender dysphoria.

HHS must uphold its mandate to support the health of all communities and not single out any group or disability with discriminatory rulemaking that undermines health and safety.

Additionally, DRC recommends that HHS extend the comment period for the proposed rule.

The standard comment period is 60 days. Not only was this comment period only 30-days (half of the normally allotted time for comment), but it also overlapped with the holiday break, and the Regulations.gov portal was unavailable for comment during part of the time period. Additionally, this decision affects the disability community, many of whom need accommodations to access information. Given the importance of this issue, the comment period should be extended.

Conclusion

The disability rights protections under Section 504 are strengthened, not weakened, by including protections for people with gender dysphoria. Section 504 must be preserved. Therefore, Disability Rights California strongly opposes this proposed rule.

Media Contact

Sam Mickens
Director of Communications
(646) 945-0918
Sam.Mickens@disabilityrightsca.org

Disability Rights California (DRC) – Is the agency designated under federal law to protect and advocate for the rights of Californians with disabilities. The mission of DRC is to defend, advance, and strengthen the rights and opportunities of people with disabilities.

• 1. According to the Journal of the American Medical Association, 17,934 people in California had a diagnosis of gender dysphoria. Schoenbrunner A, Beckmeyer A, Kunnath N, et al. Association Between California’s State Insurance Gender Nondiscrimination Act and Utilization of Gender-Affirming Surgery. JAMA. 2023;329(10):819–826. doi:10.1001/jama.2023.0878