ACA gender-affirming care protections survived a major federal court challenge affecting Maryland residents. A judge struck down a Trump administration provision restricting essential health benefit protections, reports the Baltimore Chronicle.
The decision was confirmed by the Maryland Attorney General’s Office and reported by WMAR-2 News.
Federal Judge Vacates ACA Provision
Senior U.S. District Judge Nathaniel Gorton issued the order in Massachusetts. He vacated the Essential Health Benefits provision from the administration’s final rule.
The provision excluded certain gender-affirming care from ACA essential health benefit categories. Those categories receive financial protections, including limits on out-of-pocket costs.
The ruling found that the administration changed those benefit categories without following procedures required by the Affordable Care Act.
Key facts from the case include:
- Maryland joined the lawsuit in July 2025.
- The coalition challenged 9 provisions of the federal rule.
- The latest ruling concerns the Essential Health Benefits provision.
- Seven other challenged provisions were previously vacated in separate litigation.
The lawsuit therefore extends beyond one type of medical care. States also challenged broader changes affecting access to ACA marketplace coverage.
What The ACA Ruling Means For Maryland
The dispute centered on the administration’s “Marketplace Integrity and Affordability” rule. It was proposed in March 2025 and later finalized.
| Issue | Court action | Maryland position |
|---|---|---|
| Essential health benefits | Provision vacated | State supported existing protections |
| Gender-affirming care | Exclusion struck down | Brown called the ruling a victory |
| ACA marketplace rules | Litigation continues | States challenged multiple provisions |
The ruling removes the disputed federal exclusion. It does not resolve every legal dispute over gender-affirming healthcare in the United States.
It also does not create a new nationwide healthcare mandate. The decision addresses how the federal government modified ACA essential health benefit categories.
Anthony Brown Calls Decision A Victory
Maryland Attorney General Anthony Brown said the administration attempted to remove cost protections for transgender Marylanders.
“We fought to keep that care covered, and we won,” Brown said in his August 18 statement.
The decision marks another significant court fight over federal healthcare policy and transgender medical care. Further disputes involving Medicaid, Medicare and federal funding remain active.
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