In a significant move that reverberates across multiple states, the U.S. Supreme Court on Monday threw out lower court rulings that had favored transgender individuals in lawsuits over access to gender-affirming medical care and legal recognition of gender identity. The decision comes in the wake of the Court’s controversial June 18 ruling upholding Tennessee’s ban on puberty blockers and hormone therapy for transgender minors.
The Court’s orders affect active cases in North Carolina, West Virginia, Idaho, and Oklahoma. Each case had previously resulted in favorable decisions for transgender plaintiffs who challenged restrictive state policies related to healthcare coverage and identity documents. Those decisions will now be revisited by lower courts under the new legal precedent set by the Tennessee case.
The Court did not rule on the merits of the individual cases but instructed appellate courts to reconsider them in light of the Tennessee decision. That 6–3 ruling, split along ideological lines, determined that Tennessee’s law did not violate the Equal Protection Clause of the 14th Amendment. The majority, led by Chief Justice John Roberts, pointed to “ongoing medical debate” as a justification for state restrictions.
In North Carolina, the case centered on the state employee health plan, which excludes coverage for care “leading to or in connection with sex changes or modifications.” A similar lawsuit in West Virginia challenged Medicaid’s longstanding exclusion of what it terms “transsexual surgery.” Both cases now return to the 4th U.S. Circuit Court of Appeals in Richmond, which previously found the exclusions unconstitutional.
The Supreme Court also directed the 9th Circuit to reconsider an Idaho case involving denial of gender-affirming surgical care under Medicaid. Likewise, the 10th Circuit must reexamine its decision to allow a lawsuit challenging Oklahoma’s refusal to allow transgender people to change the gender marker on their birth certificates.
These reconsiderations may reshape access to gender-affirming care and identity recognition across several states, even as the Tennessee ruling leaves some legal room for future challenges under stricter scrutiny.
Notably, the Court declined to take immediate action on three other high-profile cases involving bans on transgender students competing in sports consistent with their gender identity. Appeals from West Virginia, Idaho, and Arizona remain pending, with the Court expected to announce whether it will hear them as early as Thursday.
The justices also declined to take up a challenge to Kentucky’s ban on gender-affirming care for minors, effectively allowing that law to stand.
The wave of reconsiderations follows a broader rollback of transgender rights under the Trump administration. Since taking office in January, President Trump has reinstated a military ban on transgender service members, signed an executive order limiting the federal definition of sex to male and female, and reversed previous protections against anti-trans discrimination.
While these Supreme Court decisions do not represent final outcomes, they significantly impact the legal landscape for transgender Americans seeking equal access to healthcare and legal recognition. Advocates warn that the Tennessee ruling may embolden states to continue or expand policies targeting transgender individuals, while legal experts emphasize that room remains for future challenges under more demanding constitutional scrutiny.
As these cases return to the lower courts, the lives and rights of transgender people once again hang in the balance.
