Tennessee's Attorney General, Jonathan Skrmetti, announced a significant legal win Thursday in a case involving a Biden-era redefinition of the word "sex" to include gender identity.
Tennessee and 14 other states brought suit against the U.S. Department of Health and Human Services and the Centers for Medicare and Medicaid Services in May 2024, challenging the Biden administration's "Final Rule" which included an interpretation of the non-discrimination provision in § 1557 of the Affordable Care Act (ACA) to include gender identity (and thus, to mandate the provision of "gender affirming care").
Massive legal news‼️
— Sarah Parshall Perry (@SarahPPerry) October 23, 2025
Sec 1557 of the Affordable Care Act-the nondiscrimination provision - was manipulated to include “gender identity” under Biden & provided a mandate for medical provision of “gender affirming care.”
Today, that interpretation was ditched.
Science has won… https://t.co/b5gH9UdTSE
The suit was filed in the Southern District of Mississippi. On Wednesday, District Court Judge Louis Guirola Jr. entered summary judgment in favor of the plaintiff states and denied the defendant agencies' motion to dismiss the case.
Skrmetti's office issued a press release announcing the win, which reads (emphasis mine):
Tennessee Attorney General Jonathan Skrmetti and Mississippi Attorney General Lynn Fitch secured a nationwide victory Wednesday when a federal court struck down the Biden administration's unlawful attempt to impose gender-identity mandates on healthcare providers and state Medicaid programs through regulations implementing Section 1557 of the Affordable Care Act. The illegal gender-identity provisions of the rule, which were still on the books until this win, would have forced doctors to perform controversial gender-transition procedures and Tennessee taxpayers to fund them. The Court’s final judgment not only eliminates those provisions, it 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 (HHS) 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 healthcare and make decisions about their own Medicaid programs. Specifically, the rule would have prohibited healthcare facilities from maintaining sex-segregated spaces, required certain healthcare 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.
“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.”
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. The Court's decision to vacate the illegal provisions of the rule nationwide vindicates common sense, the integrity of our medical profession, and the rule of law. And it hobbles future attempts to smuggle radical gender ideology into our healthcare laws.
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Guirola's 26-page opinion is fairly straightforward, and his conclusion sums it up well:
A “statute cannot be divorced from the circumstances existing at the time it was passed, and from the evil which Congress sought to correct and prevent.” United States v. Champlin Ref. Co., 341 U.S. 290, 297 (1951). When it enacted Title IX, Congress’s concern was prohibiting sex discrimination in education. It was particularly concerned with inequality that female students experienced. It did not at that time contemplate gender identity, transgender status, or “gender-affirming care.”
Because Title IX and its regulations permit consideration of sex as well as separation based on sex, as noted above, the Bostock Court’s Title VII analysis cannot reasonably be applied to Title IX. Also, the refusal to provide procedures or medications for gender transition is not sex discrimination under the Bostock Court’s reasoning.
“Agencies do not have unlimited power to accomplish their policy preferences until Congress stops them; they have only the powers that Congress grants through a textual commitment of authority.” Ryan LLC v. Fed. Trade Comm’n, 739 F. Supp 3d 496, 514 (N.D. Tex. 2024). Neither Defendants nor this Court have authority to reinterpret or expand the meaning of “sex” under Title IX.
Of course, the suit was filed challenging the Biden administration. HHS and CMS are now Trump administration agencies, and it seems unlikely that this administration will challenge the District Court ruling. From a practical standpoint, the ruling vacates/removes the provisions of the Rule that relate to gender identity across the board. The question becomes who (aside from the administration) might be able to challenge the decision and how they'll attempt to do so.
For now, as Sarah Parshall Perry rightly notes, "Science has won the day!"
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