In a decision that’s already sparking heated debate across the country, a federal judge in Mississippi has struck down a Biden-era rule that would have expanded federal anti-discrimination protections to include transgender healthcare. The ruling, handed down on October 24, 2025, by Judge Louis Guirola Jr. of the U.S. District Court for the Southern District of Mississippi, marks a significant setback for the Biden administration’s efforts to broaden the scope of gender identity rights within American healthcare law.
The regulation at the heart of the case was issued by the Department of Health and Human Services (HHS) in May 2024. It sought to redefine Title IX’s prohibition against discrimination "on the basis of sex"—a clause incorporated into the Affordable Care Act (ACA) via Section 1557—to explicitly include gender identity. Under this rule, healthcare providers would have been required to offer, and states to subsidize through Medicaid, a range of treatments and procedures for gender dysphoria, including those described by critics as experimental or unproven. The rule also would have prohibited healthcare facilities from maintaining sex-segregated spaces, a longstanding practice in many hospitals and clinics.
The legal challenge was spearheaded by a coalition of 15 Republican-led states: Tennessee, Mississippi, Alabama, Georgia, Indiana, Kansas, Kentucky, Louisiana, Nebraska, Ohio, Oklahoma, South Carolina, South Dakota, Virginia, and West Virginia. Their lawsuit argued that the rule represented an unprecedented federal intrusion into states’ traditional authority over healthcare policy and Medicaid program administration. According to The Hill, the states claimed that the HHS had overstepped its authority and attempted to force "radical gender ideology into every corner of American healthcare."
Judge Guirola agreed. In his ruling, he wrote, "Congress only contemplated biological sex when it enacted Title IX in 1972. Therefore, the Court finds that HHS exceeded its authority by implementing regulations redefining sex discrimination and prohibiting gender-identity discrimination." The judge further emphasized that federal agencies could not unilaterally rewrite laws decades after their passage to advance new political agendas, a sentiment echoed by the attorneys general leading the lawsuit.
Tennessee Attorney General Jonathan Skrmetti, who played a prominent role in the litigation, celebrated the court’s decision. In a statement reported by Fox News and others, Skrmetti declared, "When Biden-era bureaucrats tried to illegally rewrite our laws to force radical gender ideology into every corner of American healthcare, Tennessee stood strong and stopped them. Our fifteen-state coalition worked together to protect the right of healthcare providers across America to make decisions based on evidence, reason, and conscience." He added, "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 Biden administration’s 2024 rule was not the first attempt to expand federal protections for transgender individuals in healthcare. The original rule was crafted during President Barack Obama’s administration in 2016, only to be reversed by President Donald Trump, who argued that such policies exceeded executive authority and ordered a review of all related executive actions. President Joe Biden’s administration then moved to reinstate and expand these protections, setting the stage for this latest legal battle.
According to Newsmax, the court had already blocked the rule from taking effect in July 2024, with Judge Guirola warning that dismissing the case or allowing the rule to stand would expose states to lawsuits and enforcement actions. The judge stated, "The Rule is in place, and the threat of enforcement and legal action is real," underscoring the urgency felt by the states involved in the lawsuit.
The ruling’s practical implications are significant. Had the rule gone into effect, it would have required hospitals and Medicaid programs nationwide to fund and perform sex-change procedures and provide transgender-related drugs and surgeries. It also would have prevented healthcare facilities from maintaining sex-segregated spaces, a move that opponents argued could compromise patient privacy and safety. The states contended that these mandates would force them to subsidize what they described as "unproven and risky procedures for gender dysphoria" through their Medicaid programs.
Supporters of the Biden-era rule, including many LGBTQ+ advocacy organizations, have argued that prohibiting discrimination based on gender identity is essential to ensuring equal access to healthcare for all Americans. They contend that denying transgender individuals medically necessary care is itself a form of discrimination and that federal law should reflect evolving understandings of sex and gender. However, the court’s decision underscores the ongoing legal and cultural battles over the meaning of "sex" in federal law and the limits of executive authority.
Judge Guirola’s ruling vacated the rule universally, meaning it cannot be enforced anywhere in the United States. While the rule had already been prevented from going into effect by earlier court actions, this decision provides what the judge described as "much-needed clarity" for states, healthcare providers, and patients alike.
The broader political context is impossible to ignore. The back-and-forth over transgender healthcare regulations has mirrored the nation’s deep partisan divides. President Trump’s administration took a hard line against what it called "gender ideology," ordering all federal agencies to eliminate related policies. Despite directives from Trump, the HHS under Health Secretary Robert F. Kennedy Jr. sought to dismiss the case, arguing it was not ripe for judgment. Judge Guirola rejected this, warning that the rule’s continued existence posed a real threat of enforcement.
The decision is widely seen as a major legal setback for efforts to institutionalize gender identity policies within federal healthcare law. Tennessee Attorney General Skrmetti summed up the mood among the coalition states, writing, "This decision restores not just common sense but also constitutional limits on federal overreach." He and others believe the ruling will make it more difficult for future administrations to revive similar mandates without explicit congressional authorization.
As the dust settles, both sides are left to ponder the next steps. Supporters of expanded transgender healthcare protections may turn to Congress, as the ruling makes clear that legislative action—rather than executive or regulatory fiat—is necessary to effect such sweeping changes. Meanwhile, opponents of the rule are celebrating the decision as a victory for states’ rights, medical conscience, and what they see as the original intent of longstanding civil rights laws.
For now, the debate over transgender rights in American healthcare remains far from settled, but Judge Guirola’s ruling has set a clear legal precedent: significant changes to federal anti-discrimination law require more than a stroke of the regulatory pen—they require the consent of Congress and, ultimately, the American people.
