Second major U.S. hospital agrees to fund detransition services under settlement with Trump DOJ

As part of a settlement with the U.S. Department of Justice, the Cleveland Clinic pledged $2 million in care for people who detransition after receiving medical interventions as minors.

The Clinic said not much is changing, because it already provides that care. But transgender advocates say the settlement with such a high-profile institution lends credibility to a politically charged effort to roll back transgender healthcare across the country.

The settlement followed a 2025 investigation into the hospital system over allegations it falsely billed insurance for what the Department of Justice called “sex-rejecting procedures on minors,” which the agreement defined as providing puberty blockers, hormone therapy, surgical interventions or voice modification interventions.

This type of healthcare is more commonly known as gender-affirming care. That’s an umbrella term for the treatment of gender dysphoria, or the discomfort that comes when someone’s gender identity differs from the sex they were assigned at birth.

“The Clinic is jumping to the front of the line to comply not with science and medicine, but with cruelty and anti-trans hate,” said Dara Adkison, executive director of TransOhio. The hospital is the second in the country to settle a dispute with the federal government by providing detransition care in the last month.

Under the agreement, the hospital also agreed to pay $308,000 to resolve the billing allegations. The dollars will go to both the federal government and the State of Ohio, whose attorney general is a party in the settlement. Additionally, the Cleveland Clinic committed to not perform or offer most medical interventions associated with gender-affirming care to minors for two decades at its hospitals across Ohio, Florida, Nevada, Canada, the United Arab Emirates and the United Kingdom.

By committing dollars to detransition care, the Cleveland Clinic is helping to “provide essential medical care for individuals living with the harmful consequences of such misguided medical interventions performed on them as children and adolescents,” a press release from the Department of Justice stated.

The hospital system largely downplayed the settlement. The Cleveland Clinic — and all hospitals in Ohio — are already banned from providing gender-affirming care to minors under state law. And a Clinic spokesperson wrote in response to questions that the hospital has always offered services to patients wanting to detransition and that the settlement simply indicates a commitment to continuing to do so.

“We are pleased to have worked collaboratively toward a resolution related to an unintentional coding issue involving a small number of patients,” wrote Angela Kiska, the executive director of public and media relations for the Cleveland Clinic, in a statement. “We remain focused on providing exceptional care to our patients and communities.”

The Cleveland Clinic does provide gender-affirming care to adults, which will not change under the settlement, a hospital spokesperson wrote in an email.

A copy of the settlement was provided to Signal Cleveland and the Buckeye Flame by the Ohio Attorney General’s office. It alleges that the Cleveland Clinic knowingly submitted claims to Ohio Medicaid with false diagnosis codes in order to “obscure the true reasons” the patients were treated, i.e. for gender dysphoria. In the settlement, the Clinic denied those allegations.

The Department of Justice wrote in a press release that the settlement with the Cleveland Clinic follows a similar case it settled with a Texas hospital last month. The State of Texas accused the hospital of billing Medicaid for illegal gender-transition interventions, including by using false diagnosis codes, the Texas Tribune reported.

As part of the agreement, the hospital had to fire five physicians who provided gender-affirming care, pay the state $10 million and create the country’s first detransition clinic, which would support individuals who are stopping or reversing the process of transitioning between genders. The care would be free to patients for the first five years.

Detransitioning can take many forms, from changing one’s name to halting hormone treatment to reversing previous surgeries. It is rare for people to regret transitioning after taking hormone therapy and surgical interventions: Between 1.3% and 2% of transgender people report dissatisfaction or regret over seeking gender-affirming health care in their lifetimes.

The Cleveland Clinic’s settlement does not appear to go as far as the Texas settlement. It asks the hospital to commit $2 million in detransition care, which can include care provided to both insured and uninsured patients. Uninsured and underinsured patients can qualify for reduced-cost or free detransition care under the hospital’s existing financial assistance policies.

“The dollar figure isn’t what we are obligated to pay, rather a commitment of care to patients who want this service — which we already do,” a hospital spokesperson wrote in a statement. It did not clarify what detransition services the hospital already provides.

The detransition services the Cleveland Clinic is supposed to provide under the agreement include “medical care for hormonal balancing, endocrine care, surgical revision and reconstruction, fertility restoration, psychological support (including grief counseling) and insurance coordination” for residents who underwent “sex-rejecting procedures” before age 19. These procedures don’t include psychiatric or psychological treatments like talk therapy.

As part of the settlement, the Clinic agreed to use its “best efforts to inform the public regarding the availability and accessibility of detransitioning services.” That includes a dedicated webpage, a dedicated phone number and a dedicated care coordinator, which the hospital agreed to have in place within 30 days.