Prohibition on Transgender Bias in Health Care Vacated by Judge

A federal agency may not enforce a May 2024 rule to the extent it prohibits discrimination against transgender people in education and health-care programs, a federal court said.

The US Department of Health and Human Services exceeded its statutory authority when it adopted the Biden-era provision that redefined “sex” under Title IX, as incorporated into Section 1557 of the Affordable Care Act, to prohibit gender-identity bias, the US District Court for the Southern District of Mississippi said Wednesday. Judge Louis Guiroloa Jr. vacated the rule and entered summary judgment for 15 challenging states.

The decision is a big loss for the trans community, but not unexpected given recent executive orders and court decisions rolling back rights in this area.

The challenged provision added gender identity to Title IX’s definition of discrimination on the basis of sex, which previously included discrimination based on sex characteristics, pregnancy, sexual orientation, and sex stereotypes. Title IX is one of four statutes whose provisions form the basis for the ACA’s anti-discrimination clause.

But a statute can’t “be divorced” from the time and reasons for its enactment, the court said. In 1972, Congress was concerned with prohibiting sex discrimination in education, and particularly with the inequality faced by female students, it said.

Additionally, the general definition of “sex” at the time focused on biological distinctions between males and females, and Congress didn’t think about gender identity, trans status, or gender-affirming care, the court said.

Guiroloa also rejected HHS’s reliance on Bostock v. Clayton County to support a rule that denying health care based on gender identity constituted sex discrimination. The Bostock court said that employers violate Title VII’s protections against sex discrimination in the workplace by firing people because they are gay or transgender.

Bostock’s analysis can’t be reasonably applied to Title IX, and doesn’t support a finding that denying health care “based on gender identity necessarily constitutes sex discrimination,” the judge said. For one, the top court didn’t intend its decision to apply to other statutes, and it later distinguished that case in United States v. Skrmetti. The later case is “instructive,” the judge said, because the provision at issue there, like the one here, denied care based on the medical diagnosis, not the patient’s sex.

Guiroloa vacated the rule universally, meaning it’s not limited to the 15 state plaintiffs. The order won’t cause any disruptions because the rule hasn’t yet gone into effect, as it’s been stayed since July 2024, he said.

The Tennessee Attorney General’s Office is lead counsel for the states. The US Department of Justice represents HHS.

The case is Tennessee v. Kennedy, S.D. Miss., No. 24-cv-161, 10/22/25.