The federal court in Mississippi has blocked the Biden administration’s effort to rewrite civil-rights rules so that gender identity becomes a federally enforceable mandate in health care and Medicaid. State attorneys general, led by Tennessee and Mississippi, challenged a 2024 HHS regulation that tried to fold Title IX’s ban on sex discrimination into the Affordable Care Act as discrimination based on gender identity. The court found HHS exceeded its authority, tossing the most intrusive parts of the rule and making it harder for future administrations to resurrect the same rewrite.
The case was brought by Tennessee Attorney General Jonathan Skrmetti and Mississippi Attorney General Lynn Fitch, and about fifteen states joined the suit in defense of state authority over health care policy. Those states included Alabama, Georgia, Indiana, Kansas, Kentucky, Louisiana, Nebraska, Ohio, Oklahoma, South Carolina, South Dakota, Virginia, and West Virginia, along with Tennessee and Mississippi. The coalition argued the rule would force doctors and hospitals into procedures and policies that violate medical judgment and state control of Medicaid funding.
At issue was an HHS regulation issued in May 2024 that reinterpreted the word sex in Title IX to cover gender identity and then layered that reinterpretation onto Section 1557 of the ACA. The court said that approach amounts to a federal grab into matters traditionally governed by states and by medical professionals, not bureaucrats in Washington. If left standing, the rule would have required changes to sex-segregated facilities, compelled some providers to participate in gender-transition care they consider unproven or risky, and pushed states to pick up the tab through Medicaid.
The court’s ruling vacated those parts of the rule and emphasized limits on executive power. The judge concluded that Congress did not give HHS the authority to reshape decades-old civil-rights language to encompass gender identity without a clear congressional command. That legal boundary matters because it prevents agencies from quietly changing statutory meaning on major questions of public policy simply by issuing a new regulation.
“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.”
The ruling didn’t just protect state sovereignty; it defended health care providers’ ability to practice based on evidence and conscience. Plaintiffs warned that the rule would have pressured clinicians to provide procedures for gender dysphoria that many consider experimental for certain age groups, and the court agreed that those concerns were not hypothetical. The decision rejects the idea that an agency can silently rewrite the reach of a federal civil-rights statute to force states and doctors into a new national policy.
“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.”
The court also addressed timing and the real-world risk that the rule posed, rejecting the government’s argument that the lawsuits were premature. The opinion noted the structure of the rule and the practical threat of enforcement, stressing that the legal fight was ripe for resolution. Courts can step in when an agency action changes the legal landscape and threatens concrete injury to states, providers, or patients.
“Plaintiffs’ claims are not premature, abstract, or contingent,” the court wrote. “The promise of HHS ‘consideration’ offers little comfort or protection from, as noted below, an overreach of executive authority. The Rule is in place, and the threat of enforcement and legal action is real. Therefore, this lawsuit is ripe for a decision.”
The decision will likely shift how future administrations approach major policy questions tied to civil-rights statutes and health care funding. Agencies that want to stretch longstanding statutory terms to cover new categories will now face a higher bar unless Congress acts expressly. That outcome preserves the role of elected lawmakers and state governments in making fundamental health-policy choices.
Politically, the ruling hands a win to conservatives and state leaders who have pushed back against what they call federal overreach disguised as regulatory change. It also sends a clear message: courts will scrutinize agency attempts to repurpose older laws to advance sweeping social policies without explicit congressional direction. For states that value local control over Medicaid and medical practice standards, the decision is a significant legal and practical victory.
Editor’s Note: The Schumer Shutdown is here. Rather than put the American people first, Chuck Schumer and the radical Democrats forced a government shutdown for healthcare for illegals. They own this.
