A federal court struck down the Biden administration's attempt to impose gender-identity mandates on health care providers and state Medicaid programs through regulations implementing Section 1557 of the Affordable Care Act.
Tennessee Attorney General Jonathan Skrmetti and Mississippi Attorney General Lynn Fitch had sued over the Biden administration's attempt to impose gender-identity mandates on health care providers and state Medicaid programs through regulations implementing Section 1557 of the Affordable Care Act. About 15 other states joined the lawsuit.
The states argued that the rules would have forced doctors to perform gender-transition procedures and force taxpayers to fund them. The Court’s final judgment eliminates those provisions, but it also makes it more difficult for future administrations to revive them.
The U.S. District Court for the Southern District of Mississippi held that the Department of Health and Human Services exceeded its authority when it issued a rule in May 2024 redefining Title IX’s prohibition against discrimination “on the basis of sex”—which Congress incorporated into the ACA through Section 1557—to include gender identity. HHS’s 2024 rule represented a disturbing federal intrusion into the States’ traditional authority to regulate health care and make decisions about their own Medicaid programs.
Specifically, the rule would have prohibited health care facilities from maintaining sex-segregated spaces, required certain health care providers to administer unproven and risky procedures for gender dysphoria, and forced states to subsidize those experimental treatments through their Medicaid programs.
In vacating the rule, Judge Louis Guirola determined that when Congress passed Title IX in 1972, "sex" meant biological sex and that federal agencies cannot unilaterally rewrite laws decades later to advance political agendas.
"In the opinion of the Court, Congress only contemplated biological sex when it enacted Title IX in 1972," Guirola wrote. "Therefore, the Court finds that HHS exceeded its authority by implementing regulations redefining sex discrimination and prohibiting gender identity discrimination."
Skrmetti welcomed the ruling.
“When Biden-era bureaucrats tried to illegally rewrite our laws to force radical gender ideology into every corner of American health care, Tennessee stood strong and stopped them,” said Attorney General Skrmetti. “Our fifteen-State coalition worked together to protect the right of health care providers across America to make decisions based on evidence, reason, and conscience. 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.”
Pr25 51 Opinion by scott.mcclallen
Tennessee, along with Mississippi, led a broad coalition of 15 states in this lawsuit, including Alabama, Georgia, Indiana, Kansas, Kentucky, Louisiana, Nebraska, Ohio, Oklahoma, South Carolina, South Dakota, Virginia, and West Virginia.