14. Department of Health and Human Services · Major
Restore the Trump-era Section 1557 and Section 504 OCR regulations
Printed page 495 14. Department of Health and Human Services
“HHS should restore Section 1557, Section 504, and other OCR regulations and fix guidance documents.”
Printed again later in the same chapter.
Printed page 496 14. Department of Health and Human Services
“Issue a proposed rule to restore the Trump regulations under Section 1557, explicitly interpreting the law not to include sexual orientation and gender identity discrimination based on the textual approach to male and female biology taken by Congress in the ACA, the need to recognize biological distinctions as part of the sound practice of health care, and the need to ensure protections of medical judgment and conscience.”
What has happened
- Partially done
HHS published notice that the U.S. District Court for the Southern District of Mississippi, in Tennessee v. Kennedy, No. 1:24-cv-161-LG-BWR, had on 2025-10-22 vacated the provisions of the 2024 Section 1557 rule that extend sex discrimination to gender identity; those provisions are legally void and the rest of the rule stands. The Biden expansion is gone, but by court order rather than by the proposed rule restoring the 2020 Trump regulation that the Mandate asks HHS to issue — and no such proposed rule has appeared. Round 3 (2026-08-28) found that one is planned but unpublished: HHS OCR carries RIN 0945-AA32, "Modify Portions of Department of Health and Human Services Regulations Implementing Section 1557 of the Affordable Care Act", new to the 2026 Unified Agenda (published 2026-08-14) with an NPRM listed for 02/2027. That question is now settled and the answer does not move this item: a dated agenda entry is `attempted` and never more (playbook §3b, settled 2026-09-01), and this item already stands above `attempted`. The entry was re-checked on 2026-09-01 against the full HHS agenda on reginfo.gov (agencyCd=0900, 183 active RINs) and no NPRM for the RIN has been published.
- Attempted
HHS proposed to revise 45 CFR 84.4(g) so that the statutory exclusion of "gender identity disorders not resulting from physical impairments" is read to encompass gender dysphoria not resulting from a physical impairment. The comment period was reopened on 2026-02-02 after technical problems; no final rule has issued.
- Attempted
HHS published a clarification that the gender-dysphoria language in the preamble to the May 2024 Section 504 final rule — language that never entered the regulatory text — "does not have the force or effect of law" and cannot be enforced. A statement about enforceability; no regulation changed.
Research log
What was searched, and what didn’t count as evidence
Research notes
- The vacatur event is dated to HHS’s Federal Register notice (2026-06-02) rather than to the court’s order (2025-10-22) because the notice is the HHS action, and because dating it to the order would put a partial event ahead of the December 2025 attempted proposed rule and leave the file’s latest Status wrong. The order date is stated in the note.
- Negative search run 2026-08-27: Federal Register full-text “Section 1557” (HHS, since 2025-01-20) — 21 documents, none a proposed or final rule restoring the 2020 Section 1557 regulation. HHS also rescinded four informal guidance documents on 2025-05-14 (“Notification of HHS Documents Identified for Rescission”); the notice’s full text was not read (the Federal Register’s text page could not be opened), so it is a lead.
- Action
- restore
- Object
- Section 1557 and Section 504 OCR regulations
- ID
- 1395