The Brief

When Gov. Gavin Newsom vetoed a bill last month that would have supported sober homeless housing, his reason left many scratching their heads.

Newsom said Assembly Bill 255, which would have allowed cities to use up to 10% of their state funds to pay for “recovery housing,” was unnecessary. That’s because using state funds for sober housing is already allowed, the governor said. He said “recent guidance” makes that clear.

That was a big surprise to Assemblymember Matt Haney, who had spent the past two years working on the bill Newsom was now saying had been moot all along. Haney had been under the impression that California’s “housing first” rule — which dictates that homelessness programs offer housing to people regardless of their sobriety, mental health, employment, etc. — meant sober housing wasn’t eligible for state funds.

When CalMatters asked about the “recent guidance” that allows the state to fund sober housing, the governor’s office sent a link to a 20-page document. No one CalMatters spoke to had ever seen that document before. Neither had Haney, anyone in his office, or the other stakeholders involved in his bill, including the service providers trying to build more sober housing, he said.

While the document was dated July, 2025, it wasn’t published online until Oct. 2 — the day after Newsom’s veto.

“I think it’s a terrible bureaucratic failure,” Haney said of the lack of communication. Having the state and the Legislature work together, rather than on separate parallel policies, would have saved everyone time and resources, he said.

“Why didn’t anybody say anything over the course of two years,” Haney asked, “not just to me, but to the cities, counties and providers who desperately wanted to open these beds?”

The California Interagency Council on Homelessness, which has been working on the document since late 2024, put the blame on Haney’s office for not reaching out. A preliminary draft was publicly available earlier this year as part of a February council meeting, said Executive Officer Meghan Marshall.

The new sober housing guidelines come at a time when the state is facing political pressure from some facets to shift its approach to homeless housing – both to embrace drug-free housing and to turn at least some of its focus from permanent housing that accepts everyone to temporary shelter that may come with strings attached.

A group of legislators, city housing staffers and nonprofits recently took a trip to San Antonio, Texas to tour a massive homeless shelter there, and returned with ideas on how to beef up California’s shelter capacity — which some on the trip say has been neglected as a casualty of California’s strict preference for long-term housing. Meanwhile, President Donald Trump’s administration has signalled that it will shift federal money away from permanent housing and into temporary shelter, while also imposing conditions such as sobriety. California might have to get on board with that agenda, or risk losing federal funds.

While few California Democrats are supportive of anything Trump does, the continued prevalence of encampments on the streets has convinced some that the state should change its tactics.

“We need to break the logjam of the dogma that says that only permanent housing is acceptable,” said Sen. Catherine Blakespear, a Democrat from Encinitas. “Because what we’re de facto saying is that people are going to stay on the streets until we’ve built enough permanent housing or market-rate housing, and neither is on track to meet the need anywhere in the near term.”

But that push has some service providers worried that, in an environment where homelessness funding keeps getting cut, focusing on sober housing and temporary housing will mean less money for the permanent housing that ends people’s homelessness.

“The current trend shifts away from solving the actual lack of a home and focuses on some people’s associated issues,” said Jennifer Loving, CEO of Destination Home.

The debate over sober, temporary, or permanent housing doesn’t address the underlying income inequality that causes many Californians to lose housing in the first place and prevents their being able to afford housing afterward.

The deal with sober housing

California has required state-funded homeless housing be “housing first” since 2016, meaning it gets people into a permanent home as quickly as possible without forcing them to jump through additional hoops. The idea is that once someone is safely housed, it becomes much easier for them to get sober, find a job or take care of other issues.

Haney argues the model prevented the state from funding sober housing, which he said could be lifesaving for people who are overcoming an addiction and don’t want to live next to neighbors using drugs.

The new state guidance says sober housing can be housing first, if it’s done right. It must be the client’s choice to get sober and live in recovery housing, and they must have other local options that don’t require sobriety. In addition, sober housing providers can’t evict someone for relapsing. If a client decides they no longer want to live in sober housing, the provider must connect them to another housing option.

The guidance is more permissive than Haney’s bill. While the bill would have capped state funding on sober housing at 10%, the state guidance has no limit. But Haney worries it’s too strict in other ways. If housing providers can’t evict someone for using drugs or alcohol, they can’t run effective sober housing, Haney said.

“There are some questions as to whether anyone is actually going to step up and do this under the guidelines as written,” he said.

The state guidelines come with no money to open new sober housing beds.

Without extra funding, as more money goes to sober housing, that means less money for low-barrier housing, said Loving, who worries that shift will move the state backward. Sober housing and drug testing were the norm in the 1980s and 1990s, but people still overdosed in those environments, she said.

“Drugs were always present, even in sober living environments,” Loving said. “And that did not increase our housing outcomes. What increased our housing outcomes was the availability of actual houses for people to transition into.”

Temporary or permanent housing?

Several dozen California legislators, city housing workers and nonprofit providers traveled to Texas last month to visit a massive homeless shelter in San Antonio. Haven for Hope fits about 1,500 people on one 22-acre campus — meaning that almost anyone in the city who wants to can sleep indoors. Most of those people are required to stay sober in order to keep their spot, and healthcare, counseling and other services are offered on site.

That program is a sharp contrast from the “discouraging results” of California’s homelessness strategy, said Sen. Dave Cortese, a Democrat from San Jose who went on the trip. He’s frustrated with what he sees as California’s neglect of temporary shelter. New programs such as Newsom’s Homekey only fund permanent housing. So did the Measure A affordable housing bond in Santa Clara County.

Long-term housing is the only way to resolve someone’s homelessness, which is why it has been the gold standard in the state. But it can take years to build, and voters aren’t always patient.

“If you push all your chips to the middle of the table on permanent supportive housing, you start to lose your constituency because constituents are coming by in their cars every day and seeing more tents and more illegal encampments,” Cortese said. “And their thought process is, ‘I thought we just put a billion dollars into eradicating homelessness. What’s going on? Why is it getting worse?’”

An illustration is displayed at The Salvation Army Silicon Valley groundbreaking ceremony for their HOPE Community Safe and Sober Overnight and Transitional Housing program in San Jose on Nov. 3, 2025.

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Nhat V. Meyer

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Land is scarce and expensive in California, which would make it hard to replicate a shelter as large as Haven for Hope. But city staff in San Jose are looking into whether some version of it can be done there, said Housing Director Erik Soliván, who was on the Texas trip.

While it may seem unusual for the Golden State to look to Texas in search of advice on social services, Californians have been awed by Haven for Hope for years. CalMatters wrote about the phenomenon in 2023.

The Texas shelter has made some changes since then. About 1,600 people slept in the shelter in 2023, and the facility served 85% of the city’s homeless population.

But even that giant facility couldn’t hold everyone. The space was overcrowded, with hundreds of people sleeping on the floor on mats inches apart. Haven for Hope had to pause enrollments and put new rules in place to limit who can come in. In the last fiscal year, the population was down to an average of 1,453 people per night. About 60% of those are in a program that regularly conducts drug and breathalyzer tests.

California will have to do more to embrace that style of shelter if it doesn’t want to get left behind by the federal administration, said Elizabeth Funk, founder and CEO of shelter provider DignityMoves, who went on the Texas trip.

The Trump administration appears poised to divert money away from permanent housing and into temporary housing that comes with sobriety and other requirements. But we won’t know the extent of that change until the government shutdown ends.

“The federal government is going to come down with a bunch of money for things that don’t allow drug use,” Funk said, “and that needs to fit in our system.”

This article was originally published on CalMatters and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.

On a chilly December night in Sandy Spring, Md., dozens of people crammed into the Woodlawn Manor for a Victorian-era Yuletide dance lesson, the wood floors creaking under the uncertain steps of 21st-century people learning 19th-century English country dances.

"Every good party has dancing," said Angela Yau, a historical interpreter for the parks department who was teaching the dances — and the Victorians loved a good Yuletide shindig.

Angela Yau, a site manager for the Montgomery County parks department who also works in cultural and natural history interpretation, wears an 1840s-style dress while teaching Victorian dances to the room.

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The merriment was emblematic of how many think of Yule; today, it's synonymous with Christmas. But centuries ago, before crooners sang about carols being sung by a fire, Yule meant something different: a pagan mid-winter festival around the solstice, dating back to pre-Christian Germanic people.

It was particularly important to Scandinavian communities during that time of year, beset by late sunrises and early sunsets, according to Maren Johnson, a professor of Nordic studies at Luther College.

"All these kinds of winter traditions are tied very intricately into small communities," she said. "You develop between yourselves a folklore about this winter time and this period of darkness."

In this week's installment of "Word of the Week," we travel back in time to the origins of Yule festivals, and trace those earliest traditions to modern-day Christmas celebrations.

Feasting, drinking and animal sacrifices

Scholars of these early pagan festivals don't have much concrete evidence of what actually went on at them, according to Old Norse translator Jackson Crawford, because much of the written record comes much later from Christians. But what is clear, he said, was that feasting and drinking were abundant.

Terry Gunnell, a professor of folkloristics at the University of Iceland, agrees. Drinking copious amounts of ale was not only encouraged but required, he said, and animals were slaughtered as part of the sacrifices to gods and spirits typical of these early festivals.

"The snow is coming down the mountains and in a sense, the nature spirits are moving closer," he said — and people wanted to appease them.

And then, there was the oath-swearing. Crawford said this was one of the major hallmarks of early Yule celebrations as recorded in myths like The Saga of Hervör and Heidrek from the 13th century. In it, a man swears to the king of Sweden that he'll marry his daughter with no real prospects of doing so.

"But your oaths during Yule are kind of sacred, extra binding," he said. "So he has to try to fulfill it," even though he eventually gets killed.

Crawford thinks that this oath-swearing could be where the word "Yule" actually comes from. The earliest roots could come from Indo-European words for "speaking," he said, and then Germanic peoples came to use it for more judicial purposes like admitting, confessing or swearing.

There's other theories out there, though, the dominant one being that the word could come from the Old Norse word hjól, meaning "wheel" — as in the "wheel of the year" that keeps turning with the seasons, Gunnell said.

Yule gets co-opted into Christmas

Christianization of this part of Europe, however, changed how people celebrated Yule. The church began to align its own holidays with pagan celebrations, Gunnell said. Easter replaced the festival at the beginning of summer, for example, and St. John's Day replaced midsummer. "And then we hear in Icelandic source material that [Yule] was replaced with Christmas," he said.

"So what the church is really doing is to allow people to go on doing what they had done before, but now under a Christian name," he added.

Around the 900s, Crawford said, Scandinavians started saying "Yule" and "Christmas" interchangeably.

"I think it suggests that, fundamentally, both of them are basically parties," he said.

That's not to say that Christmas was the exact same as the Yule celebrations of old. There was a new emphasis, Gunnell said, not so much on winter spirits but "a period of joy with the birth of Christ." But much of the feasting and drinking spirit of Yule stuck around — and became Christmas traditions throughout much of Europe.

Fast forward to the Victorian era, where the spirit of merriment became embedded in English culture, thanks to two important cultural influencers: Prince Albert, who imported traditional Yuletide customs popular in his native Germany, and Queen Victoria.

The queen fell in love with the traditions, Yau of the parks department said. And since she was a fashion icon, "These Christmas traditions really spread from the royal couple out through England and out through the colonies and everywhere else." And, as cultural customs are wont to do, the traditions morphed — creating, among other things, Santa Claus.

Still making sacrifices — just sweeter

Although slaughtering animals to please winter spirits is perhaps less typical of modern Yuletide celebrations, the spirit of sacrifice still remains, according to Gunnell.

That's particularly true in Scandinavian Christmas folklore. People leave out porridge for nisse and tomte, small trickster spirits who live in local forests, around the winter solstice in hopes of placating them or receiving gifts. (Though these days, Johnson said, many Scandinavians also celebrate the Julenisse, more of a Santa Claus figure.)

In Iceland, there's not really a Santa Claus figure at all, Gunnell said. Instead, there's the "Christmas Men," also known as the Yule lads. As the stories have told it, the mystic men – with names like "Window Peeper," "Sausage Swiper," "Bowl Licker" and "Meat Hook" — come one by one down from the mountains by your community, play pranks and steal things from homes. (To be fair to them, they'll also leave presents in windows for children.) On top of that, they have an ogress mother, Grýla, who eats misbehaving children "like sushi for Christmas," Gunnell said.

And although he doesn't swipe sausages or eat children, Santa Claus is not a completely dissimilar figure.

"The idea of sacrifices remains in leaving out a little bit of sherry or whiskey for Santa Claus and some food for the reindeer," Gunnell said.

It's something to consider the next time you leave out cookies and milk.
Copyright 2025 NPR

Carmen Peterson's son Ethan is a big fan of Elmo and Mickey Mouse Clubhouse. And although Ethan is nonverbal, he loves to sing along in his own way.

"He's a really fun-loving 8-year-old. He doesn't speak, but he gets his point across," Peterson says.

Ethan has a rare genetic disorder — Syngap1 — which, among other things, causes a kind of seizure that can make him drop to the ground without warning.

"Everything just kind of shorts out for a moment," Peterson says. "And the danger of that — and I've seen this — is him falling on hardwood floors, concrete, off of stairs, like all of these things."

She says he's gotten hurt and she's had to rush him to the emergency room.

Ethan takes a medicine called Epidiolex that prevents these seizures. But last holiday season, a thief stole it off the family's front porch in Charlotte, N.C.

Peterson remembers finding the empty box and then checking her Ring doorbell camera footage. "I see this guy walking off … and I am just livid," she says.

Then, she had to figure out how to get this medicine — worth $1,800 — replaced so her son didn't miss a dose. It turned out to be a challenge.

How many stolen packages?

December is a busy time for package deliveries and for porch pirates who steal them. Sometimes the thieves run off with mail-order medication instead of getting an iPad or a Labubu.

E-commerce took off during the pandemic, and December remains the busiest time of the year for package deliveries, according to the U.S. Postal Service.

Still, it can be tricky to get the whole picture when it comes to package theft.

As easy as it is to buy stuff online, getting it to customers is actually really complicated. That's because so many people and companies interact with a package before it's delivered, according to Ben Stickle, a professor of criminal justice administration at Middle Tennessee University.

"So it's really hard to get, you know, what happens from the point that you click a button to when it gets delivered, all put back together with enough detail to find out when and where these thefts are occurring and then actually do something about it," he says.

Stickle worked on a study with the Postal Service published earlier this year, and says that victims of theft wind up reporting it to different places that don't share information with each other or even necessarily record the missing package as "theft." And sometimes victims don't report it at all.

"There's a lot of packages stolen," he says, explaining that according to security research company SafeWise, it's about 250,000 packages every day. Stickle has worked with SafeWise.

The Postal Service report estimated that at least 58 million packages were stolen in 2024. "So what are the odds that one of those, unbeknownst to the thief, has some type of medication in it?" Nobody really knows for sure, he says.

Ways to lower theft risk

So what can you do? Stickle says scheduling deliveries for when you're home and having a delivery spot that's hidden are good ideas. Even a locker for your porch that doesn't lock is a good deterrent.

"If a thief can see that there's a package, even if it's an envelope on your porch from the roadway, it seems to be far more likely that it's going to be stolen," he says.

According to Express Scripts and Optum Rx, which are two companies that offer mail-order pharmacy services, medication theft is pretty rare.

CVS Caremark, another company that ships prescriptions by mail, said it offers customers package tracking to prevent theft, but didn't answer NPR's question about how common medication theft is.

Pharmacies, including Walgreens, say they offer order tracking and use discreet packaging to help prevent theft. Customers can also opt to require a signature when their medicines are delivered.

Making sure patients don't miss a dose is a top priority, says Stryker Awtry, the director of Loss Prevention and Transformation for Optum Pharmacy, part of Optum Rx.

"Especially during the holiday seasons when deliveries surge, we want to make sure we build in peace of mind for our customers," he says. "So if a theft were to happen, No. 1, contact the pharmacy right away."

He says to also report the theft to your prescribing doctor and local law enforcement.

A lost prescription replaced  

As for Carmen Peterson in North Carolina, when she called her insurer's pharmacy to get Ethan's medicine replaced, the answer was no. But Ethan missing a dose and having a seizure that put him in the emergency room again? Not an option for her.

"It's just like it's one of those things that you just don't have a choice," she says.

If forced to, she would have found the money to buy the medicine herself.

"It was just unfortunate that the … company was so ready and kind of willing to just wash their hands of it because they felt like they had done what they were contracted to do, which is deliver the medication."

That company, Liviniti Pharmacy, said it couldn't comment on the Peterson family's experience because of patient privacy laws.

Unwilling to give up, Peterson reported the theft everywhere and made noise about it — including on her local news stations. That worked. Jazz Pharmaceuticals, the company that makes the drug Ethan needs, saw the stories and replaced it for her within a week.

Now, she recommends getting important medicines delivered to a P.O. box, a workplace or just going to the pharmacy to pick it up yourself.

Copyright 2025 NPR

What’s good for Riverside County is good for the whole state: After a pilot to automatically admit high school students into the California State University system in the Inland Empire county took off last fall, lawmakers this year passed a law to greenlight a similar program statewide next fall.

Leaders at the California State University last year launched the pilot to attract more students to the university system and to steer some to campuses that have been struggling with enrollment declines.

The pilot worked like this: University officials and high schools in Riverside County pored over student course completion and grade data to identify every county high school senior who was eligible for admission to the 10 of 22 Cal State campuses chosen for the pilot. Then the students received a brochure in the mail last fall before the Nov. 30 submission deadline, plus digital correspondence, telling them they were provisionally admitted as long as they submitted an application to one or more Cal State campuses, even those not in the pilot, and maintained their high school grades.

Starting next fall, all students in California will be eligible for the automatic admissions program, which will expand the roster of participating Cal State campuses to 16. Cal State will release more information on the program’s implementation in February, its website says.

In justifying the expanded program during a legislative hearing, bill author Sen. Christopher Cabaldon, a Democrat from Napa, said college should be as seamless a transition from high school as it is for students finishing one grade and advancing to the next. “It's entirely an invention of us, the gap between 12th grade and college. … The same gap does not exist between elementary school and junior high or junior high and high school.”

The legislation, Senate Bill 640, passed without any opposition and was signed into law by the governor. The program doesn’t mean students can enter any major at the campuses they pick. Some majors may require students to show higher high school grades or tougher courses if those programs have fewer openings than student demand. For Californians, the standard minimum GPA for entry is 2.5 in a series of college-preperatory courses.

Students will also be free to apply to the six other over-enrolled Cal State campuses, though admission isn’t guaranteed. Those are Fullerton, Long Beach, Pomona, San Diego, San Jose and San Luis Obispo.

What the Riverside pilot did

High school counselors told CalMatters that the Riverside County pilot encouraged students who never considered attending a university to follow through with the automatic admissions process. Counselors also reached out to some students who were a class or two short of meeting the requirements for Cal State admission to take those, encouraging more students to apply to college who otherwise wouldn’t have. Younger students who were off the college-course taking track might be emboldened to enroll in those tougher high school courses knowing automatic admission is in the cards, the counselors said.

Silvia Morales, a senior at Heritage High School, a public Riverside County high school, got an automatic admissions letter last fall. “I was pretty set on going to community college and then transferring, because I felt like I wasn’t ready for the four-year commitment to a college,” she said. She eventually submitted her forms, encouraged by her high school counselor.

Following the Riverside pilot, Cal State campuses saw roughly 1,500 more applicants and 1,400 more admitted students in 2025 compared to 2024, though just 136 more students enrolled.

The data for Riverside County reviewed by CalMatters suggests that more applicants and admitted students through an automatic admissions policy doesn’t translate into more enrolled students. Colleges closely follow their "yield rates" — the percentage of admitted students who ultimately enroll. In 2024, the Cal State yield rate for Riverside County was about a third. But in 2025, it declined by a few percentage points, meaning a lower share of admitted students selected any Cal State campus.

This suggests that the system will have to work harder to convert admitted students into ones who actually enroll, said Iwunze Ugo, a research fellow at the Public Policy Institute of California, particularly with students who would not have applied were it not for the automatic admissions program.

Automatic admissions doesn’t mean automatic enrollment

While admission to a college overcomes a major hurdle to eventually enrolling, there are numerous steps necessary before students sit down for their first college course. Accepted students must submit additional grades, put down a deposit, complete registration forms and actually show up for the fall term. Students who were less engaged in the college-going culture are more likely to “melt” during the process between acceptance and enrollment, some studies show, though researchers say this can be reversed with additional outreach to students at risk of not enrolling.

And even with an automatic admissions program, students must still register online and complete the application, which many students under the Riverside pilot didn’t do. Cal State sent out more than 17,000 automatic admissions notices to students, and just under 12,000 formally applied to at least one Cal State campus. Those who didn’t apply may have chosen another option, such as the often more selective University of California, private campuses, community colleges, or no college at all.

“I think that'll be incumbent on the CSU to pick up some of that slack and encourage students admitted through this path to go through the rest of the process and ultimately end up at a CSU campus,” Ugo said.

Cal State officials also recognize this. “Students who apply independently tend to have stronger self-directed interest, and therefore stronger intent to enroll,” said April Grommo, a senior Cal State official who oversees enrollment management. More direct engagement with students admitted through this program will be necessary, she said.

Some campuses with a recent history of declining enrollment got a tiny pick-up from the pilot. San Francisco State saw 311 more applications from Riverside County in 2025 than in 2024. That translated to 11 more enrolled students, a review of Cal State data shows.

A statewide program may steer more students to attend campuses with enrollment woes, even if the “yield rate” declines. That’s because if the rate of new students enrolling doesn’t rise as quickly as the number of students admitted, the yield rate drops.

Under the expanded statewide program, Grommo said the system anticipates “enrollment growth as well, but not necessarily at the same rate as applications and admits,” she added.

And as the economy shows signs of decay, the prospect of a college degree may compel more high schoolers on the fence to attend Cal State; System data show students from there earn a typical salary of $71,000 five years after graduating with a bachelor’s degree. Postsecondary enrollment tends to rise as the number of available jobs decreases, a social science phenomenon in which employers are more selective about who they hire, compelling many job-seekers to hit the books to show they’re more trained.

Of course, souring economies often result in less public funding for colleges as state budgets are beleaguered, which may lead to fewer professors and staff for a growing cadre of students. “But I think generally, having more students is not a problem,” Ugo said.

This article was originally published on CalMatters and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.

NEW YORK — A coalition of 19 states and the District of Columbia on Tuesday sued the U.S. Department of Health and Human Services, its secretary, Robert F. Kennedy Jr., and its inspector general over a declaration that could complicate access to gender-affirming care for young people.

The declaration issued last Thursday called treatments like puberty blockers, hormone therapy and surgeries unsafe and ineffective for children and adolescents experiencing gender dysphoria, or the distress when someone's gender expression doesn't match their sex assigned at birth. It also warned doctors that they could be excluded from federal health programs like Medicare and Medicaid if they provide those types of care.

The declaration came as HHS also announced proposed rules meant to further curtail gender-affirming care for young people, although the lawsuit doesn't address those as they are not final.

Tuesday's lawsuit, filed in U.S. District Court in Eugene, Oregon, alleges that the declaration is inaccurate and unlawful and asks the court to block its enforcement. It's the latest in a series of clashes between an administration that's cracking down on transgender health care for children, arguing it can be harmful to them, and advocates who say the care is medically necessary and shouldn't be inhibited.

"Secretary Kennedy cannot unilaterally change medical standards by posting a document online, and no one should lose access to medically necessary health care because their federal government tried to interfere in decisions that belong in doctors' offices," New York Attorney General Letitia James, who led the lawsuit, said in a statement Tuesday.

The lawsuit alleges that HHS's declaration seeks to coerce providers to stop providing gender-affirming care and circumvent legal requirements for policy changes. It says federal law requires the public to be given notice and an opportunity to comment before substantively changing health policy — neither of which, the suit says, was done before the declaration was issued.

A spokesperson for HHS declined to comment.

HHS's declaration based its conclusions on a peer-reviewed report that the department conducted earlier this year that urged greater reliance on behavioral therapy rather than broad gender-affirming care for youths with gender dysphoria.

The report questioned standards for the treatment of transgender youth issued by the World Professional Association for Transgender Health and raised concerns that adolescents may be too young to give consent to life-changing treatments that could result in future infertility.

Major medical groups and those who treat transgender young people have sharply criticized the report as inaccurate, and most major U.S. medical organizations, including the American Medical Association, continue to oppose restrictions on transgender care and services for young people.

The declaration was announced as part of a multifaceted effort to limit gender-affirming health care for children and teenagers — and built on other Trump administration efforts to target the rights of transgender people nationwide.

HHS on Thursday also unveiled two proposed federal rules — one to cut off federal Medicaid and Medicare funding from hospitals that provide gender-affirming care to children, and another to prohibit federal Medicaid dollars from being used for such procedures.

The proposals are not yet final or legally binding and must go through a lengthy rulemaking process and public comment before becoming permanent. But they will nonetheless likely further discourage health care providers from offering gender-affirming care to children.

Several major medical providers already have pulled back on gender-affirming care for young patients since Trump returned to office — even in states where the care is legal and protected by state law.

Medicaid programs in slightly less than half of states currently cover gender-affirming care. At least 27 states have adopted laws restricting or banning the care. The Supreme Court's recent decision upholding Tennessee's ban means most other state laws are likely to remain in place.

Joining James in Tuesday's lawsuit were Democratic attorneys general from California, Colorado, Connecticut, Delaware, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, New Jersey, New Mexico, Oregon, Rhode Island, Vermont, Wisconsin, Washington and the District of Columbia. Pennsylvania's Democratic governor also joined.
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