Maryland AG Obtains Court Order Protecting Gender-Affirming Care Under Affordable Care Act

Maryland Attorney General Anthony G. Brown, as part of a multistate coalition, has announced a significant court ruling regarding gender-affirming care. The U.S. District Court for the District of Massachusetts has ruled against an element of a Trump administration regulation which sought to remove coverage for specific types of gender-affirming care from the health benefits mandated by the Affordable Care Act (ACA).

The legal challenge targeted a rule known as the “Marketplace Integrity and Affordability” rule, initially proposed by the Trump administration in March 2025. This rule was presented as a measure to combat fraud within ACA enrollment and to reduce federal expenditures on subsidies designed to assist individuals in affording ACA coverage. However, the regulation included provisions that would have excluded certain gender-affirming medical treatments from the ten categories of essential health benefits guaranteed by the ACA. The coalition, including Attorney General Brown, filed a lawsuit in July 2025, challenging nine distinct provisions of this final rule. Their arguments centered on the assertion that these provisions would impede consumer access to ACA coverage, increase financial burdens on states, and undermine essential ACA protections. It is noted that seven of these challenged provisions had previously been vacated through separate litigation in the U.S. District Court for the District of Maryland.

The recent ruling by the U.S. District Court for the District of Massachusetts specifically addressed the Trump administration’s modification of essential health benefit categories. The court determined that these changes were unlawfully implemented, as the administration did not adhere to the procedural requirements stipulated by the ACA. This decision upholds the principle that gender-affirming care, when deemed medically necessary, should remain a covered benefit under the ACA’s essential health benefits framework, thereby protecting individuals from potentially prohibitive out-of-pocket costs. The outcome of this legal battle directly impacts transgender individuals in Maryland and across participating states, ensuring continued access to necessary healthcare services without the threat of coverage exclusion from essential benefits.

Article by Mel Anara, based upon information from the Maryland Attorney General.

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