HHS Final Rule Says Gender Dysphoria Is Not a Disability Under Section 504

The US Department of Health and Human Services published a final rule on Friday, Oct. 30, stating that gender dysphoria not resulting from a physical impairment does not qualify as a disability under Section 504 of the Rehabilitation Act of 1973. The department's Office for Civil Rights issued the rule, which applies to programs and activities that receive HHS funding, from hospitals and clinics to child welfare agencies and universities.

What the rule changes

Section 504 bars discrimination based on disability in programs that receive federal money. Congress wrote a list of exclusions into the law, among them gender identity disorders not resulting from physical impairments. The final rule writes those exclusions into the HHS regulation at 45 C.F.R. 84.4(g) and states that gender dysphoria not resulting from a physical impairment falls inside that exclusion. HHS said the rule aligns its regulations with the exclusions Congress wrote into law, and that it fits with Executive Order 14168 and the administration's deregulatory agenda in Executive Order 14219. A claimant will no longer be able to rely on gender dysphoria without a physical cause as the qualifying disability in an HHS Section 504 case. The rule does not decide whether a particular person's condition has a physical basis, and it does not remove protections that exist under other civil rights laws.

A reversal of the 2024 position

The department's 2024 final rule never named gender dysphoria in its regulatory text, but its preamble suggested the condition could qualify as a disability. In April 2025, HHS put a notice in the Federal Register stating that the preamble has no force or effect of law and that the regulation did not address gender dysphoria. Secretary Robert F. Kennedy Jr. announced the proposed rule at an event in Washington, D.C. in December 2025. HHS said it reviewed more than 380 comments on the proposal and kept the operative text unchanged. The rule is scheduled to take effect 60 days after its Nov. 3 publication in the Federal Register.

A court ruling points the other way

In 2022, the US Court of Appeals for the Fourth Circuit held in Williams v. Kincaid that a transgender woman had plausibly alleged that gender dysphoria could be protected under the Americans with Disabilities Act and the Rehabilitation Act. The Supreme Court declined to review the case in 2023, leaving that ruling in place in the Fourth Circuit. The final rule acknowledges that Williams is the only federal appellate decision that squarely addresses the issue, and it reaches the opposite interpretation. That gap between the rule and the court ruling sets up likely litigation over which reading controls.

Reaction

Bloomberg Law reported that the rule follows a series of moves by HHS and other agencies to restrict services and protections for transgender people. The Center for Public Representation, which joined coalition comments opposing the proposal, said the rule removes protection from people with gender dysphoria and called the change politically motivated. Supporters of the proposal, including groups that filed comments backing it in January, argued that Congress never intended gender dysphoria to count as a disability and that the 2024 preamble had stretched the statute.