Read more at NBC News.

The Trump administration directed 40 states, five territories and Washington, D.C., to remove references to transgender people from their sex education programs or risk losing federal funding.

The Administration for Children and Families (ACF), a division of the Department of Health and Human Services, sent letters Tuesday demanding that the health departments in these states and territories remove “all references to gender ideology” from their Personal Responsibility Education Program, or PREP. The program is a federally funded initiative created in 2010 to help prevent teen pregnancy and sexually transmitted infections.

“Accountability is coming,” acting Assistant Secretary Andrew Gradison said in a statement. “Federal funds will not be used to poison the minds of the next generation or advance dangerous ideological agendas. The Trump Administration will ensure that PREP reflects the intent of Congress, not the priorities of the left.”

The 40 states that received letters are: Alabama, Alaska, Arizona, Colorado, Connecticut, Delaware, Georgia, Hawaii, Illinois, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Utah, Vermont, Washington, West Virginia, Wisconsin and Wyoming. The five U.S. territories are: Guam, Northern Mariana Islands, Palau, Puerto Rico and the U.S. Virgin Islands.

Links to all 46 letters were included in the administration’s press statement. The ACF’s four-page letter to New York, for example, includes a bulleted list of course content that was flagged during a “medical accuracy review” earlier this year and “must be removed from New York’s PREP curricula and program materials.”

The content flagged for removal includes definitions of gender identity and gender expression and directives that program facilitators allow students to share their pronouns and “demonstrate acceptance and respect for all participants, regardless of personal characteristics, including race, cultural background, religion, social class, sexual orientation or gender identity,” according to the letter.

If New York’s health department declines to comply, it could lose more than $6 million in federal funds, according to data provided by ACF. The other states and territories stand to lose $300,000 to $4.6 million each.

The letters come just days after the ACF terminated $12 million of California’s remaining PREP funding after the state’s health department declined to remove references to trans people from the curriculum, arguing that the references had already been approved by the agency, the materials were medically accurate and relevant to the statute, and ACF does not have the authority to take such an enforcement action, according to ACF’s termination letter to the state.

California’s health department has 30 days to appeal. A spokesperson for the department said in a statement that the state maintains its position that its PREP curriculum “is medically accurate, comprehensive, and age-appropriate.”

“CA PREP sexual health education curriculum promotes healthy relationships and reduces the rates of sexually transmitted infections (STIs) and unintended pregnancy, as well as leads to delayed sexual activity in youth — all outcomes that lead to a healthier state,” the spokesperson said.

In an emailed statement, Elana Ross, a spokesperson for California Gov. Gavin Newsom, said, “If it’s a day ending in y, President Trump is attacking kids’ safety, health, and access to education as part of his culture war.”

The action from ACF is part of the Trump administration’s ongoing effort to prohibit federal recognition of trans people and penalize the use of federal funds for any program that includes or mentions them.

In the first few weeks of his presidency, Trump issued executive orders declaring that there are only two unchangeable sexes; prohibiting trans people from enlisting and serving in the military; barring trans girls and women from competing on female sports teams in federally funded K-12 schools and colleges; and barring federal funding from going to hospitals that provide transition-related care to minors. The federal government has taken several actions against providers of transition care, resulting in more than 20 hospitals over the last few months rolling back or ending their gender-affirming care programs for minors and some young adults.

Federal officials have also removed mentions of trans or intersex people from agency websites, including from the website for the Stonewall National Monument commemorating the site of the 1969 Stonewall uprising in New York, which is widely considered a turning point in the modern gay rights movement.