Overview
- A federal judge vacated the part of the 2025 Marketplace Integrity and Affordability Final Rule that would have barred non‑grandfathered individual and small‑group plans from treating certain gender‑affirming care as an Affordable Care Act essential health benefit.
- The ruling protects ACA‑linked financial safeguards for affected patients by keeping gender‑affirming services eligible for federal subsidies and subject to limits on out‑of‑pocket costs when covered by marketplace plans.
- A coalition of 20 states and Pennsylvania Gov. Josh Shapiro sued to block the rule, and state attorneys general hailed the decision as a win for access and affordability for trans people.
- Judge Gorton left four other challenged parts of the 2025 rule intact, and the administration has separately finalized a rule that would cut federal Medicaid and CHIP funding for gender‑affirming care for minors.
- Because the ruling is narrow, insurers and states will still decide coverage choices and advocacy groups should watch further litigation and administrative actions that could reshape access and costs for transgender patients.