The US District Court for the District of Massachusetts has struck down a key provision of a Trump Administration final rule that would have excluded coverage of certain types of gender-affirming care as essential health benefits under the Affordable Care Act.
Delaware Attorney General Kathy Jennings was part of a coalition of attorneys general who filed a lawsuit in July of 2025 challenging 9 provisions of the final rule – 7 were later vacated in separate litigation in the US District Court for the District of Maryland. The US District Court for the District of Massachusetts has ruled that the Trump Administration unlawfully modified the categories of essential health benefits without following the proper procedures the ACA requires.
Additional information from AG Jennings:
Essential health benefits are subject to the ACA’s financial protections, including limits on out-of-pocket costs.
“Since day one, my office has been fighting to stop the Trump Administration’s war on transgender Americans because it’s not just despicable and cruel – it’s also plainly illegal,” said Attorney General Kathy Jennings. “The transgender community was here long before this corrupt Administration put a target on their backs, and they’ll be here long after it’s been confined to the dust heap of history.”
The final rule at issue — the “Marketplace Integrity and Affordability” rule — was proposed by the Trump Administration in March 2025 to curb alleged ACA enrollment fraud and reduce federal spending on subsidies that help consumers afford ACA coverage. Among other changes, the rule would have removed certain types of gender-affirming care from the ACA’s 10 essential health benefit categories.
In July 2025, Attorney General Jennings and the coalition filed a lawsuit challenging nine separate provisions of the final rule, arguing that they would make it harder for consumers to get coverage through the ACA, increase costs for states, and weaken key ACA protections. Seven were later vacated in separate litigation, City of Columbus et al. v. Kennedy et al., in the U.S. District Court for the District of Maryland. Yesterday, the U.S. District Court for the District of Massachusetts ruled that the Trump Administration unlawfully modified the categories of essential health benefits without following the proper procedures the ACA requires.
