A federal judge has struck down portions of a Biden-era regulation interpreting federal health care nondiscrimination law to cover gender identity, siding with Tennessee and 14 other states that sued the U.S. Department of Health and Human Services.
On October 22, 2025, U.S. District Judge Louis Guirola Jr. of the Southern District of Mississippi granted summary judgment to a 15-state coalition and vacated provisions of HHS’s May 6, 2024, Section 1557 final rule to the extent they interpreted sex discrimination to include gender identity. The court also issued a declaratory judgment that HHS exceeded its statutory authority by adopting that interpretation and by issuing related regulations on gender-affirming care.
The case—State of Tennessee, et al. v. Kennedy, et al.—was brought by Tennessee and joined by Mississippi, Alabama, Georgia, Indiana, Kansas, Kentucky, Louisiana, Nebraska, Ohio, Oklahoma, South Carolina, South Dakota, Virginia, and West Virginia. The plaintiffs challenged parts of the 2024 rule that amended multiple HHS and CMS regulations and, among other things, identified gender identity as a form of sex discrimination under Section 1557 of the Affordable Care Act, which incorporates Title IX’s prohibition on sex discrimination.
“In the opinion of the Court, Congress only contemplated biological sex when it enacted Title IX in 1972,” Judge Guirola wrote. “Therefore, the Court finds that HHS exceeded its authority by implementing regulations redefining sex discrimination and prohibiting gender-identity discrimination.”
Citing specific provisions of the rule, the court noted that covered entities—including state-run health benefit exchanges and recipients of Medicaid and Medicare funds—would have been barred from denying or limiting health services sought for gender transition or other gender‑affirming care if those services are provided for other purposes and the denial is based on sex assigned at birth or gender identity. The judge concluded that HHS lacked authority to extend Title IX’s meaning of sex to gender identity via Section 1557 and vacated the identified provisions on a nationwide basis.
The ruling followed a July 3, 2024, preliminary injunction that had already paused enforcement of the rule’s gender-identity provisions. After a change in administration in January 2025, HHS sought dismissal on ripeness grounds, pointing to new executive orders and asserting there was no realistic threat of enforcement. The court rejected that argument, finding the rule remained on the books and that “the threat of enforcement and legal action is real,” warranting a final decision on the merits.
Tennessee Attorney General Jonathan Skrmetti praised the outcome, saying the coalition had prevented an unlawful reinterpretation of federal law. “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,” he said in a statement reported by the Daily Wire.
HHS finalized its Section 1557 rule on May 6, 2024, stating that sex discrimination includes, among other categories, gender identity. Multiple courts issued stays or preliminary injunctions against aspects of the rule in 2024, and Wednesday’s decision converts those temporary limits into a final judgment vacating the challenged provisions to the extent they treat gender identity as sex under Title IX as incorporated into Section 1557.
