By Celia Hack & Ken Schneck
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.
Here’s how the Cleveland Clinic will invest in detransition care
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.
Advocates distinguished between providing detransition care and promoting it.
“Detransition services were always a part of gender affirming care,” said Adkison, of TransOhio. “There continues to be no increased need, and it is a bigoted, sad performative farce the Clinic is choosing to promote.”
The Clinic didn’t respond directly to Adkison’s comments.
Access to care for minors already under fire in Ohio
The Republican supermajority in the Ohio legislature passed the “SAFE Act” in 2023, an Ohio law banning all types of gender-affirming health care for transgender minors. Gov. Mike DeWine vetoed the bill, but Republican lawmakers cut short their winter vacation to override the veto.
The Supreme Court of Ohio heard oral arguments on March 24 in a lawsuit challenging the SAFE Act.
In April 2024, a common pleas judge put the ban on gender-affirming care on hold with a temporary restraining order after the American Civil Liberties Union (ACLU) of Ohio filed a lawsuit on behalf of two transgender girls – Madeline Moe and Grace Goe – at risk of losing access to health care under the “SAFE Act.”
Yost filed an emergency motion to block the restraining order, which the courts granted, meaning that gender-affirming care for minors remains banned pending the outcome of the Ohio Supreme Court case.
Republicans ‘vindicated’
Ohio Republicans took to social media to praise the settlement.
Rep. Gary Click (R-Vickery), the primary sponsor of the SAFE Act, posted on X that “miscoding is a known problem” and that he hopes that “other children’s hospitals are paying attention.”
In a statement provided to Signal Cleveland and The Buckeye Flame, Click highlighted that “the SAFE Act” has progressed through both the legislative and judicial processes in Ohio with individuals testifying both for and against the legislation. He stated there is an expectation that healthcare providers follow the law regardless of their own stance on an issue.
“It is a black mark on one of the nation’s leading hospitals that they would flaunt the law to pursue a political ideology,” Click said.
In a statement, a spokesperson for the hospital wrote that it has “complied and will continue to comply with all federal and state laws.”
Other Republicans also chimed in. Rep. Josh Williams (R-Sylvania Township) posted on X Sunday that the Republican party is “vindicated” by the agreement.
Still, trans advocates say that the settlement will not “stop trans youth from growing into amazing trans adults.”
“Ohio is incredibly trans and queer, and no one person, hospital, or government agency will change that,” Adkison said. “We know who we are, we’ll look out for each other, and that’s all that matters today and always.” 🔥
IGNITE ACTION
- If you are a young LGBTQ+ person in crisis, please contact the Trevor Project: 866-4-U-Trevor.
- If you are an transgender adult in need of immediate help, contact the National Trans Lifeline: 877-565-8860
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