NEW YORK (AP) — 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.