A federal court has invalidated a Biden-era rule that expanded federal anti-discrimination law to cover "gender identity," a move that would have required hospitals and Medicaid programs to fund and perform sex-change procedures.
U.S. District Judge Louis Guirola Jr. in Mississippi ruled that the Department of Health and Human Services (HHS) exceeded its authority by redefining "sex discrimination" under Title IX and the Affordable Care Act.
His decision, granting summary judgment to 15 states, stated that neither the agency nor the court could expand the statutory meaning of "sex" without congressional authorization.
The rule, issued in 2024 during President Joe Biden's administration, would have forced health providers to offer transgender-related drugs and surgeries and required states to fund the treatments through Medicaid.
The court initially blocked the rule in July 2024. After President Donald Trump took office, his administration dropped the government's appeal and ordered all federal agencies to eliminate policies advancing gender ideology.
Despite those directives, HHS under Health Secretary Robert F. Kennedy Jr. sought to dismiss the case, arguing it was not ripe for judgment.
Guirola rejected that claim, writing that the agency had failed to comply with Trump's executive orders or take steps to rescind the rule. He warned that dismissing the case would have reinstated the policy, exposing states to lawsuits and enforcement actions.
"The Rule is in place, and the threat of enforcement and legal action is real," Guirola wrote, concluding that the Biden-era regulation represented "an overreach of executive authority."
The ruling is viewed as a major legal setback for efforts to institutionalize gender identity policies within federal healthcare law.
Tennessee Attorney General Jonathan Skrmetti said the decision prevents future administrations from easily reviving similar mandates and ensures medical decisions remain grounded in evidence and conscience.
He wrote in a release that, "This decision restores not just common sense but also constitutional limits on federal overreach, and I am proud of the team of excellent attorneys who fought this through to the finish."
The coalition of 15 states, led by Tennessee and Mississippi, also included Alabama, Georgia, Indiana, Kansas, Kentucky, Louisiana, Nebraska, Ohio, Oklahoma, South Carolina, South Dakota, Virginia and West Virginia.
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