The Trump administration opened a new civil rights investigation this week that LGBTQ+ advocates argue is intended to limit access to health care for transgender people, leveraging federal “conscience rights” enforcement to determine who can receive care.
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The U.S. Department of Health and Human Services’ Office for Civil Rights announced in a press release on Tuesday that it is investigating whether a state health department’s licensing rules for behavioral health providers violate federal protections for religious and moral objections, focusing on requirements to participate in or refer for abortion care or “sex-rejecting procedures.”
HHS described the action as protecting faith-based providers’ ability to participate in health care without violating their beliefs.
“Amid a national shortage of behavioral health providers, every qualified professional is essential to meeting the needs of people in crisis,” Office for Civil Rights director Paula M. Stannard said in the press release. “OCR is committed to ensuring that faith-based organizations can contribute fully and that no provider is asked to violate their religious beliefs or moral convictions as they step forward to serve.”
But policy experts say the investigation marks a deliberate escalation.
A former senior HHS official said the announcement functions as an enforcement action rather than a rule change, creating legal uncertainty for providers. Rapid reversals between administrations have left health systems struggling to keep up, especially in areas like gender-affirming care, they said.
That instability, advocates say, is not accidental.
Adrian Shanker, who served as deputy assistant secretary for health policy under President Joe Biden, said the investigation reflects a sustained campaign to use federal civil rights enforcement to restrict transgender health care nationwide and to intimidate providers into discontinuing care altogether. He said the administration is deploying the Office for Civil Rights not as a neutral enforcer of patient protections, but as a political instrument aimed at suppressing access to gender-affirming medicine.
He noted that HHS’s language, grouping “sex-rejecting procedures” with female genital mutilation, conflates transgender medical care with criminal acts, while the government shows little urgency about nonconsensual surgeries on intersex children. “They're only obsessed with preventing trans people from accessing the care that their bodies need,” he said.
The investigation will rely on the Equal Treatment for Faith-Based Organizations rule and federal conscience statutes, which prohibit penalizing providers who refuse to provide certain services on religious grounds.
This is the fifth conscience rights investigation announced during Trump’s second term, part of a broader effort to preserve religious exercise, according to HHS.
But Shanker said these investigations are meant to deter care.
Shanker said public announcements of federal enforcement actions are designed to create fear across the medical system, signaling that the government is watching closely and prepared to intervene. The result, he said, is often “compliance in advance,” in which hospitals and clinics quietly scale back or abandon services, especially gender-affirming care, before any formal penalties are imposed.
Some states have strengthened requirements for behavioral health providers after reports that patients were turned away from abortion, contraception, or gender-affirming care. These rules often require objecting providers to offer timely referrals.
Under the Trump administration, such requirements may now be treated as unlawful coercion of religious providers.
For transgender people, the consequences are severe. Behavioral health professionals are often the gateway to care for gender dysphoria, depression, and anxiety—conditions that disproportionately affect trans youth and adults amid increasing political attacks.
HHS did not identify the state under investigation or disclose what triggered the probe. The agency urged individuals who believe they were discriminated against on the basis of religion or the “exercise of conscience” in HHS-funded programs to file complaints with the Office for Civil Rights.
“This administration is obsessed with targeting trans folks,” Shanker said.
