The Colorado Supreme Court ruled Monday that Children’s Hospital Colorado should resume providing gender-affirming care to transgender youth.
In a 5-2 decision, the state’s highest court concluded there is sufficient evidence that Children’s violated state antidiscrimination law when it suspended gender-affirming care earlier this year in the face of mounting federal threats.
The majority ordered the case be returned to a lower court, where it said a judge should issue an injunction requiring that Children’s resume the care, which in this instance includes prescriptions for things like puberty blockers or hormone therapy.
Writing for the majority, Justice William Hood wrote that Children’s — or CHC, as Hood short-handed it — had continued providing puberty blockers and hormone therapy to cisgender children when medically appropriate. That made the decision to stop providing them to transgender youth discrimination.
“CHC’s decision to suspend medical gender-affirming care to youth denies petitioners the full and equal enjoyment of services based on gender identity,” he wrote.
In a dissent, Justice Brian Boatright wrote that the majority opinion too easily dismisses the context in which Children’s made its decision: threats from the federal government that could result in the entire hospital system being shut because of its provision of gender-affirming care. Justice Carlos Samour joined the dissent.
Boatright wrote that the majority’s opinion “completely minimizes the reality of the situation. Furthermore, it brushes off these drastic consequences as speculative.”
Tumultuous months
The decision caps a tumultuous 15 months for transgender youth who receive prescriptions for gender-affirming hormones or puberty blockers at Children’s.
In February 2025, Children’s first suspended gender-affirming care following an executive order by President Donald Trump that vowed to crack down on the practice. The hospital resumed providing care later that month after a federal judge blocked the order.
In July, the U.S. Department of Justice subpoenaed Children’s for sensitive patient medical information, employee personnel files, internal emails, billing records and other documents are part of an investigation into the off-label use of prescriptions for gender-affirming care, though the government acknowledged it had no evidence of wrongdoing.
Children’s is fighting in court to quash the subpoena. A magistrate judge has recommended that the subpoena be quashed, calling the DOJ’s investigation “a smokescreen for its true objective” of trying to end gender-affirming care through intimidation. A final order has not yet been issued, though.
Then in December, U.S. Department of Health and Human Services Secretary Robert F. Kennedy Jr. issued a declaration finding that gender-affirming care for youth is neither safe nor effective. The declaration said hospitals that provide the care could be punished, and an HHS official announced later that month that Children’s had been referred for investigation to the agency’s inspector general.
As a result of the ensuing investigation, Children’s could be kicked out of the Medicaid system, which would mean the hospital could not collect payment for care provided to any Medicaid patient for any purpose. Roughly half of the patients seen by Children’s are covered by Medicaid.
Exclusion from Medicaid, though, would also have broader implications, which is why the rarely used federal sanction is known as a death sentence for hospitals. Children’s officials have said their contracts with private insurance companies would collapse, as would their partnerships with doctors. The hospital could lose its accreditation, and state regulators may as a result pull its license.
Care suspended
Children’s announced just after the New Year that it had again suspended gender-affirming medical care for trans youth under the age of 18. While the hospital has continued to offer mental and behavioral health services, it stopped writing new prescriptions for hormones and puberty blockers to trans youth.
The hospital does not perform gender-affirming surgeries and has never done so for patients under 18.
This time, several transgender patients and their families sued Children’s, arguing that the decision violates a state antidiscrimination law. They said Children’s has continued to provide hormone therapy and puberty blockers to cisgender youth when medically appropriate, and they said the sudden halt to care for transgender youth had devastating consequences to their kids’ mental and physical health.
“It’s hard as a parent to be told by the same provider that this is the care your child needs, and see firsthand the relief that this care gives your children,” one parent, known in court as Denisha Doe, said following a hearing in February. “It truly is lifesaving. And then to have that same institution turn their back on you in this way feels like, well, my child’s life is expendable.”
A lower court judge ruled in February that the families would likely be able to succeed in proving discrimination and in proving that they’ve been harmed. But the judge ultimately sided with Children’s, denying the families’ request for an injunction that would force Children’s to resume care.
Denver District Judge Ericka F. H. Englert wrote that granting the injunction would place Children’s at risk of federal punishment and “would pose a grave danger to the public interest that is greater than the danger to plaintiffs.”
Appeal to the Supreme Court
The families appealed to the Colorado Supreme Court, where justices appeared split on the question during oral arguments in April.
One question that loomed large during the arguments was about the threat Children’s faced. If the justices were to order Children’s to resume care, how likely is it that the federal government would punish the hospital?
While the appeal was pending, a federal judge in Oregon said he would block the declaration by Kennedy that threatened punishment for gender-affirming care. Based on that, an attorney for the families said during arguments before the state Supreme Court that the risk of punishment was “completely imaginary.”
But Children’s has continued to insist it would risk federal sanction by resuming care. The hospital maintained that argument even after the Oregon judge expanded his ruling to preclude any federal effort to kick a hospital out of Medicaid because it provides gender-affirming care.
Children’s instead pointed to the Department of Justice investigation, which continues to generate legal fights over subpoenas issued to hospitals across the country.
“The Department of Justice’s latest attack reinforces the shifting and unrelenting nature of its efforts to use potential civil and criminal liabilities to attack providers of gender affirming care,” the hospital wrote in a filing to the state Supreme Court earlier this month.
But attorneys for the families suing the hospital were skeptical, saying fights over subpoenas issued to other hospitals have “no relevance” to the lawsuit.
“Petitioners respectfully request that this court follow the law of the state of Colorado and prohibit the hospital from refusing to provide gender-affirming care to children because of their gender identity,” they wrote.
This is a developing story and will be updated.
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