By Celia Hack and Ken Schneck
As part A settlement with the US Department of JusticeThe Cleveland Clinic has committed $2 million to care for people who migrated to another country as children after receiving medical intervention.
The clinic claims that little is changing because it already provides such care. But transgender advocates say the settlement with such a high-profile institution gives credence to politically charged efforts to roll back health care for transgender people across the country.
The settlement took place a Investigation in 2025 to the hospital system over allegations that it falsely billed insurance for what the Justice Department called “gender rejection procedures for minors,” which the settlement defined as providing puberty-blocking drugs, hormone therapy, surgical interventions or voice modifications.
This type of health care is commonly known as gender-affirming care. This is a general term for the treatment of gender dysphoria, which is the discomfort that occurs when someone’s gender identity is different from the sex they were assigned at birth.
“The clinic is jumping to the front lines to uphold not science and medicine, but cruelty and hatred against transgender people,” said Dara Adkison, executive director TransOhio. It’s a hospital second in the country resolve a dispute with the federal government by providing resettlement care over the past month.
Under the agreement, the hospital also agreed to pay $308,000 to resolve billing allegations. The dollars will go to both the federal government and the state of Ohio, whose attorney general is a party to the settlement. Additionally, the Cleveland Clinic has pledged for two decades not to perform or offer most medical interventions related to gender-affirming care for minors at its hospitals in Ohio, Florida, Nevada, Canada, the United Arab Emirates and the United Kingdom.
By donating money for relocation care, the Cleveland Clinic helps “provide vital medical care to those who struggle with the harmful consequences of such erroneous medical interventions in childhood and adolescence.” – we read in a press release from the Department of Justice.
The hospital system largely downplayed the settlement. The Cleveland Clinic – and all hospitals in Ohio – are already prohibited from providing gender-affirming care to minors in accordance with state law. A spokesperson for the clinic wrote in response to questions that the hospital has always offered services to patients wishing to transfer to another hospital and that the settlement is simply a commitment to continue doing so.
“We are pleased to have worked together to resolve an unintentional coding issue that affected a small number of patients,” Angela Kiska, executive director of public and media relations at Cleveland Clinic, said in a statement. “We remain focused on providing exceptional care to our patients and communities.”
The Cleveland Clinic delivers gender-affirming care for adultswhich will not change as part of the settlement, a hospital spokesman wrote in an e-mail.
AND copy of the settlement was provided to Signal Cleveland and Buckeye Flame by the Ohio Attorney General’s office. It alleges that the Cleveland Clinic knowingly submitted claims to Ohio Medicaid containing false diagnosis codes in order to “obfuscate the real reasons” why patients were being treated, i.e., for gender dysphoria. In the settlement, the Clinic rejected these allegations.
Here’s what Cleveland Clinic will invest in resettlement care
The Justice Department said in a news release that the settlement with the Cleveland Clinic follows a similar case it reached last month with a hospital in Texas. The state of Texas has accused a hospital of billing Medicaid for illegal gender reassignment interventions, including the exploit of false diagnosis codes, – reported the Texas Tribune..
As part of the settlement, the hospital had to fire five doctors who provided gender-affirming care, pay the state $10 million and establish the nation’s first re-entry clinic to support people stopping or reversing their gender transition. Care will be free for patients for the first five years.
A change in status can take many forms, from changing your name, to stopping hormone treatment, to reversing previous surgeries. It is uncommon for people to regret the change after hormone therapy and surgical interventions: Between 1.3% and 2% transgender people report dissatisfaction or regret about seeking gender-sensitive health care throughout their lives.
The Cleveland Clinic settlement does not appear to extend as far as the Texas settlement. It asks the hospital to allocate $2 million for post-relocation care, which could include care provided to both insured and uninsured patients. Uninsured and underinsured patients may qualify for reduced-cost care or free transitional care under the hospital’s existing financial assistance policies.
“The dollar amount is not what we are obligated to pay, but rather a commitment to care for patients who want this service – which we already do,” a hospital spokesman said in a statement. It was not made clear what resettlement services the hospital already provides.
The re-settlement services the Cleveland Clinic is expected to provide under the contract include “medical care for hormone balance, endocrine care, surgical revision and reconstruction, fertility restoration, psychological support (including grief counseling) and insurance coordination” for residents who underwent “sex rejection procedures” before the age of 19. These procedures do not include psychiatric or psychological treatment, such as talk therapy.
As part of the settlement, the Clinic agreed to exploit its “best efforts to inform the public about the availability and affordability of resettlement services.” This includes a dedicated website, a dedicated phone number and a dedicated care coordinator, which the hospital has agreed to hire within 30 days.
Supporters make a distinction That resettlement care i promotion This.
“Resettlement services have always been a part of gender-affirming care,” said Adkison of TransOhio. “There is still no increased demand and this is a bigoted, sad performative farce that the Clinic chooses to promote.”
The clinic did not respond directly to Adkison’s comments.
Access to care for minors already under fire in Ohio
The Republican majority 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 brief their winter vacation to override the veto.
The Supreme Court of Ohio he heard oral arguments on March 24 in a lawsuit challenging the SAFE Act.
In April 2024, an appellate judge suspended the ban on gender-affirming care under a ephemeral restraining order after American Civil Liberties Union (ACLU) of Ohio filed a lawsuit on behalf of two transgender girls – Madeline Moe and Grace Goe – who are at risk of losing access to health care under the SAFE Act.
Yost submitted an extraordinary motion block court-issued restraining orders, meaning gender-affirming custody of minors remains prohibited until the Ohio Supreme Court case is resolved.
Republicans “Justified”
Ohio Republicans took to social media to praise the settlement.
Rep. Gary Click (R-Vickery), lead sponsor of the SAFE Act, published in October that “miscoding is a known problem” and that he hopes “other children’s hospitals will take notice.”
In a statement provided to Signal Cleveland and The Buckeye, Flame Click emphasized that the “SAFE Act” has gone through both the legislative and judicial processes in Ohio, with individuals testifying both for and against the legislation. He said health care providers are expected to follow the law regardless of their own position on an issue.
“The fact that one of the country’s leading hospitals flaunts the law to advance a political ideology is a black mark,” Click said.
In a statement, a hospital spokesman said the hospital “has and will continue to comply with all federal and state regulations.”
Other Republicans also got involved. Rep. Josh Williams (R-Sylvania Township) published in October Sunday that the Republican Party was “vindicated” by the deal.
Still, trans advocates say the settlement “will not stop trans youth from growing into amazing trans adults.”
“Ohio is incredibly trans and queer and no person, hospital or government agency will change that,” Adkison said. “We know who we are, we will take care of each other and that is all that matters today and always.” 🔥
START ACTION
- If you are a juvenile LGBTQ+ person in crisis, please contact Trevor’s project: 866-4-U-Trevor.
- If you are a transgender adult in need of immediate support, please contact National Trans Lifeline: 877-565-8860
