On October 30, 2026, HHS finalized a rule amending its regulations implementing Section 504 of the Rehabilitation Act. The rule clarifies that the statutory exclusion for “gender identity disorders not resulting from physical impairments” includes gender dysphoria not resulting from a physical impairment.
The rule amends HHS’s existing Section 504 regulations and applies to recipients of HHS financial assistance, such as grants, premium tax credits, Medicare, or Medicaid. It is scheduled for publication in the Federal Register on November 3, 2026, and will take effect 60 days after publication.
HHS Clarifies the Section 504 Definition of Disability
Section 504 prohibits discrimination on the basis of disability in programs and activities receiving federal financial assistance. The Rehabilitation Act excludes certain conditions from the definition of disability, including “gender identity disorders not resulting from physical impairments.”
HHS’s 2024 Section 504 rule discussed whether gender dysphoria could qualify as a disability, but the regulatory text did not expressly address the issue. In April 2025, HHS clarified that the 2024 rule’s preamble language did not have the force of law and that the regulation did not establish gender dysphoria as a disability.
The new rule amends the regulations at 45 C.F.R. § 84.4(g) to expressly include gender dysphoria not resulting from a physical impairment within the statutory exclusion. HHS bases its interpretation in part on the medical terminology in use when Congress enacted the exclusion.
The rule does not address gender dysphoria resulting from a physical impairment, which may still qualify as a disability if it satisfies the other requirements of Section 504.
Other Section 504 Requirements Remain in Place
The rule addresses the definition of disability and does not rescind the other requirements established by HHS’s 2024 Section 504 rule, including requirements addressing accessibility, effective communication, and nondiscriminatory medical treatment.
The rule also addresses Williams v. Kincaid, a Fourth Circuit decision holding that gender dysphoria is not categorically excluded from protection under the Americans with Disabilities Act as a gender identity disorder. HHS maintains its interpretation of the statutory exclusion while acknowledging that Williams is binding precedent in Maryland, North Carolina, South Carolina, Virginia, and West Virginia.
Implications for HHS Funding Recipients
The rule may affect how HHS funding recipients evaluate whether gender dysphoria qualifies as a disability under Section 504.
HHS states that recipients will not need to change their policies, procedures, or practices as a result of the rule.
However, recipients should consider the rule alongside other applicable federal and state nondiscrimination requirements and relevant judicial decisions. This is particularly important for organizations operating in the Fourth Circuit, where Williams remains binding precedent.
Groom’s Health Services practice will continue to monitor developments affecting Section 504 and federal nondiscrimination requirements for health care organizations.
Read the final rule here.
