UPMC’s new agreements with the Trump administration’s Department of Justice require the healthcare system to stop providing gender-affirming care to minors for 10 years, but courts or politics could shorten that timeline.
Gender-affirming care remains legal in Pennsylvania, and the agreements announced this month don’t resolve six complaints filed against UPMC on behalf of transgender children and 18-year-olds who were denied care as of June 2025. Those complaints are being reviewed by the state Human Relations Commission.
The complaints allege, among other things, that UPMC is providing puberty blockers and hormone therapy to children who are not transgender while denying them to transgender youth, according to Elizabeth Lester-Abdalla, a staff attorney with the Women’s Law Project, which filed the complaints.
The commission hasn’t yet issued a ruling on the complaints. If a ruling doesn’t arrive by the end of this month, one year after the complaints were originally filed, the families that brought the complaints could sue UPMC, according to Lester-Abdalla.
The agreements between UPMC and the DOJ include language that would allow the health care system to start treatment for minors again if the Pennsylvania Supreme Court or the United States Supreme Court issued a final ruling that not doing so violated federal or state law. “In the event of such an order, UPMC’s obligations … are terminated,” one agreement reads.
The Human Relations Commission enforces state laws that prohibit discrimination, and is overseen by nonpartisan commissioners appointed by the governor. Four days after President Donald Trump was sworn in, the commission issued a statement saying it would continue to enforce discrimination claims, including protections for “gender identity or expression, affectional or sexual orientation and differences in sexual development,” despite a freeze on federal civil rights investigations.
“We look forward to the commission investigating this and hope that the commission can just live up to its obligations under the Pennsylvania Human Relations Act to investigate discrimination complaints,” said Lester-Abdalla. UPMC “can put whatever they want in their agreement,” the attorney added. “That doesn’t mean that it’ll be upheld by a court of law under scrutiny.”
UPMC didn’t respond to an inquiry about the complaints before the commission.
On Sunday, more than 30 members and allies of the transgender community picketed outside UPMC Children’s Hospital in Lawrenceville to protest the settlement. The protesters, Organized by AIDS Coalition to Unleash Power (ACT UP Pittsburgh), condemned UPMC’s commitments and called upon Mayor Corey O’Connor and Allegheny County to address the gap in access to gender-affirming care.
The potential for a court-ordered end to the agreements between UPMC and the Department of Justice was among other details in the pact that were not initially reported after both entities announced its existence on Sept. 18.
Two agreements, different ages
UPMC has posted links to two separate-but-related agreements with the administration. They provide conflicting information about whether UPMC will treat 18-year-olds as children or adults.
Last year UMPC said it had stopped providing gender affirming care for anyone under 19 years old. The Women’s Law Center has filed complaints against UMPC for not treating 18-year-olds who are considered legal adults. “I don’t think any of their termination of care is defensible, but certainly” not “18-year-old adults,” said Lester-Abdalla.
The agreements use the phrase “under the age of 18” twice near the top to describe federal accusations against UPMC. But in one of the agreements the definition for covered conduct includes the phrase “an individual under 19.”
UPMC didn’t respond directly to a question seeking clarity on how it will treat 18-year-olds under the agreement.
Additional privacy protections
In a statement to Public Source, UPMC lists three main reasons for settling with DOJ:
- To protect patient privacy
- To protect the confidentiality of private health information
- To resolve a billing practice investigation.
“The agreement includes important privacy, confidentiality, and non-prosecution protections for patients, legal guardians, providers and employees,” the statement says.
Advocates for patients say health records were already protected by a federal court ruling in Western Pennsylvania. The court ruled that “DOJ was not entitled to these records because of both the privacy interests in the records and the fact that the Department of Justice was seeking them for an improper purpose,” according to Mimi McKenzie, a lawyer for the Public Interest Law Center that successfully sued to prevent the department from getting records of gender-affirming care.
The DOJ appealed the ruling but then dropped its appeal, she said. “So, there wasn’t really a situation in which their records would be turned over.”
McKenzie said the families she represents are “relieved that their children’s personal records aren’t being turned over to a government that is extremely hostile to them.” But the attorney said they were not consulted on UPMC’s agreement with the department. “UPMC is not standing up for appropriate health care, not standing by some of their most vulnerable patients,” McKenzie said.
McKenzie said the new agreement does provide additional protection for UPMC because her lawsuit had only stopped the Department of Justice from receiving three out of about 15 types of information the federal agency had requested through a subpoena of the healthcare nonprofit. Without the new agreement, McKenzie said, UPMC may have had to provide documents and information for the DOJ’s investigation of its billing practices.
Payment may be well less than $1 million
The department laid out its accusations against UPMC in the agreements, accusing the nonprofit of billing insurance companies for endocrine disorders “rather than what the United States contends is an accurate diagnosis code” for gender dysphoria or other gender related disorders.
The agreements say UPMC “may have engaged in fraudulent billing practices by making gender dysphoria diagnoses and/or by billing insurance providers for ‘medically necessary’ drugs to treat gender dysphoria where the patients did not meet the criteria for reimbursement” from insurers.
UMPC denies the accusations. “This agreement does not reflect a conclusion or admission that UPMC, or any other subcomponent or affiliated entity thereof, is subject to suit or liability under federal civil or criminal law,” one of agreements states.
But the agreements require the healthcare giant to go back and change how it billed for some gender-affirming services and issue refunds to the federal government. Those refunds, however, would be credited against the $950,000 UMPC already agreed to pay to resolve false claims allegations.
The agreements also require UMPC to change how it bills for gender-affirming care, provide training to ensure compliance with those changes and recertify that it is in compliance with the overall agreement every year.
UPMC may cooperate against drug companies
The agreement further requires UPMC to help the Department of Justice with investigations of drug companies that, it alleges, may have been involved in deceptive practices in how they marketed and sold drugs for gender-affirming care.
This includes encouraging UPMC employees to speak to the department about any manufacturers, retailers or distributors of drugs and “produce records of any relevant communications between its employees and pharmaceutical manufacturers” of drugs involved in gender-affirming care.
Wait until after ‘28?
With any court processes likely to take years, a change in political fortunes could provide quicker relief. A Justice Department overseen by a president who supports gender-affirming treatment for minors could agree, alongside UPMC, to alter or scrap the agreement entirely, Lester-Abdalla said. “The parties may also amend the term of any provision of this agreement by mutual consent,” the agreement reads.
As a transgender health care provider, protester Mer Kee witnessed the effects of the ban at her clinic first-hand.
“I’ve had someone who had to turn away due to the ban, and they were bawling in the appointment room,” Kee said at the Sunday protest. “This wasn’t a law, this wasn’t something which was legislated. This was just a fiat decision made by people who fell in line because they’re being intimidated at the federal level.”
Public Source spoke with 10 protesters who identified as transgender. All said they were concerned about the settlement’s potential ripple effects on access to gender-affirming care across the board.
“It doesn’t matter if they reverse this in two years, in five years. They have already done irreparable damage to the community of Pittsburgh,” said B Kleymeyer, an organizer with ACT UP Pittsburgh. “We know that these kids are never going back to UPMC. They could start doing the care again tomorrow. These kids do not trust that hospital.”
This loss of trust, Kee said, leads to the denigration of “institutional knowledge.”
“That includes both things on the medical end, but also equally important and much faster, is the loss of cultural knowledge,” she said. “How do we engage with trans patients in a culturally competent way? How do we make them feel comfortable? How do we make them feel like this is a place where they can trust their doctor, where they can trust they will be getting the best care?”
Protesters said that most children will end up foregoing “lifesaving” care.
A 2022 survey conducted by the UCLA Williams Institute noted that 58% of transgender people aged 16 to 17 reported suicidal thoughts within that past year, compared to only 14% of their adult counterparts.
“I’m very lucky to have made it out of my teen years alive,” said protester Rho Kall, 23. “And if I had access to gender-affirming care as a teenager, it would have been a lot less of a struggle for me. I barely graduated high school. I didn’t go to college. I feel like I’m just getting my life started now.
“Kids are going to die, that is what’s going to happen. People are desperate. It makes you desperate.”
Lester-Abdalla said UPMC has not offered a healthcare-based justification for denying care. “This is care that UPMC was proud to promote on their website for over a decade as providing and nothing has changed in the medical community about this care,” she said. “Every major medical association in America continues to support this care.”
Although McKenzie was unable to provide details about what families are doing in the absence of care from UPMC, she said the families are allowed to seek treatment with other healthcare providers in Pennsylvania who are still providing gender-affirming care to minors.
“I’ve heard just anecdotally, not specifically from our clients, that parents are doing whatever they can to try and continue the treatment for their children,” she said, “whether it’s from providers outside of UPMC, private providers or traveling.”
Oliver Morrison is the health and environment reporter at Pittsburgh’s Public Source and can be reached at oliver@publicsource.org.
Octavia Liku is an editorial intern at Pittsburgh’s Public Source and can be reached at octavia@publicsource.org.
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