Cleveland Clinic agrees to 'decades-long' halt on gender-affirming care for minors in DOJ settlement

Cleveland Clinic is the next major health system to enter a deal with the Trump administration’s Justice Department promising not to deliver certain gender-affirming care to minors and committing resources toward detransition services. 

The deal was announced by the DOJ Friday and confirmed by Cleveland Clinic. It includes a $308,000 payment resolving allegations of false billings submitted to public and private payers, and a promised $2 million from the health system “to provide restorative care for detransitioners … regardless of their insured status or ability to pay.”

Additionally, the department said Cleveland Clinic has made “a decades-long commitment to not perform or offer sex-rejecting procedures—which includes the administration of puberty blockers and cross-sex hormones—for minors.” 

Cleveland Clinic referred to the DOJ when asked for clarity around the terms of those commitments (Fierce Healthcare has requested from DOJ a copy of the agreement for review), but confirmed that it had struck an accord with the department.

“We are pleased to have worked collaboratively toward a resolution related to an unintentional coding issue involving a small number of patients,” the system told Fierce Healthcare in an emailed statement. “We remain focused on providing exceptional care to our patients and communities. We have complied and will continue to comply with all federal and state laws.”

Gender-affirming care comprises several services ranging from gender-sensitive mental healthcare to hormonal treatments and, less frequently, surgical interventions. The services have historically been supported by most major medical associations, including the American Academy of Pediatrics and the American Medical Association.

Delivering most of these services is currently illegal for minors under Ohio state law. Similar laws have been enacted in 26 states, according to Human Rights Campaign. 

The administration has taken a hard stance on the services it views as harmful since returning to the White House in early 2025, enacting a pressure campaign of subpoenas, investigations and regulatory threats to cow pediatric care providers.

While several of those efforts have been restricted or blocked by judges, the administration has notched some concrete wins. DOJ last month announced a deal with Texas Children’s Hospital similar to that with Cleveland Clinic, in which the pediatric system said it would end the services, pay millions of dollars to settle false billing allegations and create a first-in-the-nation “detransition clinic.” That announcement came shortly after word of a grand jury subpoena sent to providers in early May that appears to be returning requested information from some organizations. 

The DOJ, in its Friday announcement, said Cleveland Clinic had also entered an agreement with the Ohio Attorney General, and that the system “remained cooperative, proactive, and solution-driven” throughout law enforcement’s investigation. It also noted that the resolution brings no determination of liability, and that Cleveland Clinic continues to deny all allegations against it.

“I am grateful that institutions like Cleveland Clinic and Texas Children’s have decided to be part of the solution, not part of the problem,” Brett Shumate, assistant attorney general for the Civil Division, said in DOJ’s announcement. “Cleveland Clinic’s commitment to providing millions of dollars towards care for detransitioners is emblematic of just that. I am grateful for this resolution with Cleveland Clinic, but our work is far from over, and our division will continue to work tirelessly to protect America’s children and hold accountable those that have preyed on vulnerable children, whether they be pharmaceutical companies or medical providers.”