Fighting to Prevent Gender Discrimination for Hospice Patients
October 5, 2026
Woodhull Freedom Foundation Response to Proposed Data Collection Modifications by the Centers for Medicare & Medicaid Services within the Department of Health and Human Services: Privacy Act of 1974; System of Records
Woodhull Freedom Foundation is a national organization dedicated to defending and protecting sexual freedom as a fundamental human right. Woodhull protects individuals’ rights across the United States to enjoy sexual dignity, privacy, and consensual sexual expression without societal or governmental interference, coercion, or stigmatization. In carrying out this work, we defend the rights, health, and safety of Transgender, Nonbinary, and Gender Expansive individuals. It is in this capacity that we submit this comment to oppose the proposed data collection modifications to the “Hospice Outcomes and Patient Evaluation (HOPE)” systems of record from the Centers for Medicare & Medicaid Services (CMS) within the Department of Health and Human Services (HHS), published in the Federal Register on September 9, 2026.
This proposed data collection modification does not explicitly state that they are part of efforts to enforce the White House’s Executive Order 14168 “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government.” However, the proposed changes include modifying the “Categories of Records” section for data elements about hospice patients to replace the data element “gender” with “sex.” We are deeply disturbed by this data collection modification because it will interfere with accurate patient demographic record keeping at CMS and HHS more broadly.
This proposed data collection modification reflects Executive Order 14168’s efforts to make it the United States policy to recognize only two sexes, male and female. This proposed rule reinforces this effort by removing the data element “gender” and replacing it with “sex” for patient record keeping within the HOPE systems of record. The recognition of only two sexes is not only scientifically inaccurate but extremely harmful to the mental and physical well-being of gender diverse individuals. We include here a brief excerpt from our Fact Checked by Woodhull series, which addresses the reality of sex and gender:
“Sex and gender are complex and exist on a spectrum, yet society often creates narrow, rigid categories that fail to reflect this diversity. These restrictive categories can cause harm by excluding and shaming anyone who exists outside of these lines, especially transgender and intersex people. Being forced into categories that do not align with identity can cause discrimination and violence in families, healthcare, and social systems. This can have serious long-term emotional and physical consequences for individuals who are outside of these lines. For example, transgender youth reported significantly increased rates of depression, suicidality, and victimization compared to their cisgender peers. These are often accompanied by struggling with belonging in school, family issues, and internalized self-stigma.”
It is imperative that HHS and all federal government policies accurately represent the complexities of sex and gender. We include in this comment PDFs of Woodhull publications, which provide accurate language that should be used in public policy related to gender and sex:
This proposed modification from HHS threatens human rights and civil protections for millions of people throughout the United States and furthers the cruel attacks against transgender, non-binary, and gender expansive individuals. We also raise alarm at the fact that this is all part of a nationwide assault on trans people that is so dire that the Lemkin Institute for Genocide Prevention and Human Security has warned that policies targeting transgender people in the United States are indicative of the early stages of genocide.
We call on HHS to recognize the proposed data collection modification’s inherent harms to equality and scientifically accurate patient recordkeeping and reject its implementation.