In a staggering blow to LGBTQ rights this Friday, the Department of Health and Human Services (HHS) has announced it will no longer enforce LGBTQ protections in its health programs.

The latest move could impact millions of LGBTQ people who get services at HHS-funded health centers. As of today, HHS grant recipients can discriminate against people because of their sexual orientation or gender identity. One such example? Under this new rule, federally funded programs are no longer obligated to treat same-sex married couples as such.

HHS states it is following the lead of Congress, the Supreme Court, and well, itself. HHS distributed more than $1.2 trillion in 2019. Their programs touch on everything from HIV prevention, to substance abuse treatment, to services for homeless Americans.

HHS has already made moves to remove the Affordable Care Act’s (ACA) LGBTQ nondiscrimination protections, hailed as landmark for transgender people. (That rollback has not yet been finalized.) But earlier this year, HHS did cement policy that shields health care workers from treating trans patients who claim a religious or moral objection.

Friday’s new policy also invokes “religious freedom” under the guise of anti-LGBTQ discrimination.

“These require that the federal government not infringe on religious freedom in its operation of HHS grant programs and address the impact of regulatory actions on small entities,” the statement from HHS reads.

In a press statement, Mara Keisling, executive director for the National Center for Transgender Equality, slammed the move as a “moral crime and severe abdication” of the department’s mission to preserve public health:

This rule is an abuse of taxpayer dollars in the name of empowering hatred and bigotry towards society’s most vulnerable members. Stigma and prejudice are fueling a public health crisis among transgender people across the country, one that manifests itself as suicide, addiction, intimate partner violence, and HIV.

Transgender Americans in particular already face high rates of discrimination in health care. The 2015 U.S. Transgender Survey found that more than a third of trans people in the U.S. (33%) had a negative experience with a health care provider related to being trans in that year alone. Nearly a quarter (23%) actively avoided seeking medical care because they feared discrimination.