WASHINGTON — The Department of Health and Human Services has finalized a rule stating that gender dysphoria not resulting from a physical impairment is not a disability under Section 504 of the Rehabilitation Act, the 1973 law that bars disability discrimination by recipients of federal funds. The department says the change is needed “to ensure compliance with the best reading of the governing statute.”
The final rule, signed by Health and Human Services Secretary Robert F. Kennedy Jr. on Oct. 29, is scheduled to be published in the Federal Register on Tuesday and will take effect 60 days later. It was posted for public inspection ahead of publication.
The rule amends HHS’s Section 504 regulations, at 45 CFR Part 84, to say that the department reads the law’s exclusion of “gender identity disorders not resulting from physical impairments” from the definition of disability “to encompass ‘gender dysphoria not resulting from a physical impairment.’” HHS said the clarification was necessary “to resolve ambiguity introduced in the preamble” to a 2024 rule issued under the Biden administration.
HHS’s Office for Civil Rights, which enforces Section 504, wrote that the rule “is not based on an effort to harm a population for political gain” and “does not make a judgment on whether gender dysphoria not resulting from physical impairments is ‘legitimate’ or a ‘true disability.’” It said people with gender dysphoria remain covered by federal laws barring discrimination based on race, color, national origin, sex, age and disability, “to the extent applicable.”
How the rule came about
The 2024 rule, published May 9, 2024, updated HHS’s Section 504 regulations for the first time in decades. Its regulatory text was silent on gender dysphoria, but its preamble stated that “gender dysphoria does not fall with[in] the statutory exclusions for gender identity disorders.”
In April 2025, HHS issued a notice saying the preamble “does not have the force or effect of law” and “cannot be enforced.” The department proposed codifying its reading in a proposed rule published Dec. 19, 2025, and said it received more than 380 comments, which it described as “divided in support for and opposition to the proposed rule.”
The statute’s exclusion list, which matches language in the Americans with Disabilities Act of 1990, also names “transvestism, transsexualism” and several other conditions. HHS said its reading was “informed, in part, by the relevant medical diagnostic history” of the term “gender identity disorders” in the DSM-III-R, the psychiatric manual in effect when Congress wrote the exclusions. Later editions of the manual replaced “gender identity disorder” with “gender dysphoria.”
The court split
The rule addresses the only federal appeals court ruling on the question. In Williams v. Kincaid, a 2022 decision, the U.S. Court of Appeals for the Fourth Circuit held that gender dysphoria can qualify as a disability under the ADA. The Supreme Court declined to hear the case in 2023; two justices dissented from that denial.
HHS wrote that Williams “is binding precedent within federal courts in Maryland, North Carolina, South Carolina, Virginia, and West Virginia,” but that it “applies only to the Fourth Circuit” and “diverges with the rulings of numerous other courts.” The department also cited Texas v. Kennedy, a lawsuit by state attorneys general in federal court in Lubbock, Texas, challenging the 2024 rule’s preamble.
Commenters who opposed the rule told HHS it “would significantly restrict discrimination protections for individuals who identify as transgender” and could lead to people “being turned away from basic services,” according to the department’s summary of comments. Supporters said it would ensure that only “legitimate disabilities” received protection, a characterization the department declined to adopt.
What changes
The rule applies to hospitals, clinics, state Medicaid agencies, universities and other entities that receive HHS funding. Under it, those recipients would not face Section 504 claims premised on gender dysphoria not resulting from a physical impairment. Within the Fourth Circuit, the Williams decision remains binding on federal courts interpreting the ADA.
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