BALTIMORE – Maryland Attorney General Anthony G. Brown along with several of the top nations attorneys general has secured a significant court victory as part of a multistate coalition challenging a Trump administration rule that would have excluded certain types of gender-affirming care from essential health benefits under the Affordable Care Act.

The U.S. District Court for the District of Massachusetts struck down a key provision of the final rule, ruling that the administration unlawfully modified the categories of essential health benefits without following proper procedures required by the Affordable Care Act (ACA).

Essential health benefits are subject to the ACA’s financial protections, including limits on out-of-pocket costs. The administration’s rule would have removed certain types of gender-affirming care from the ACA’s 10 essential health benefit categories, potentially making such care more expensive for patients.

“The Trump Administration tried to make essential care unaffordable for transgender Marylanders by stripping it out of the Affordable Care Act’s cost protections,” said Maryland Attorney General Brown. “We fought to keep that care covered, and we won. My Office will always defend Marylanders’ right to the care they need.”

“Everyone deserves access to health coverage,” said California Attorney General Bonta. “The Trump Administration tried to exclude gender-affirming care from qualifying as an essential health benefit. We fought back, and the court’s ruling means this care can — and in many states must — qualify for the ACA’s financial protections, ensuring transgender people have an equal opportunity to benefit from the ACA.”

“The federal government tried to illegally deny promised health coverage that Washingtonians rely on,” said Washington State Attorney General Nick Brown. “As this administration tries to make health care more expensive and difficult to access, we will fight to keep it as affordable and accessible as possible in Washington.”

The final rule, known as the “Marketplace Integrity and Affordability” rule, was proposed by the Trump administration in March 2025. The administration said the rule was intended to curb ACA enrollment fraud and reduce federal spending on subsidies that help consumers afford coverage.

In July 2025, Attorney General Brown and the coalition filed a lawsuit challenging nine separate provisions of the final rule. The coalition argued that the provisions would make it harder for consumers to get coverage through the ACA, increase costs for states, and weaken key ACA protections.

“This rule would have made it harder for people to get the care they need and pushed costs onto families who are already managing serious health decisions,” said Portland Oregon Attorney General Rayfield. “Those are decisions that belong between a patient and their doctor. This court ruling shows that Trump can’t use health care laws to engage in discrimination.”

“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 Delaware 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.”

“Last year, the Trump Administration rolled out mountains of new red tape to charge Americans more money for worse coverage, including politically motivated exclusions on gender-affirming care. We sued, and we stopped them, and we’re going to keep fighting to protect access to affordable healthcare free from partisan interference,” said Connecticut Attorney General William Tong.

Seven of those provisions 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. The Massachusetts ruling addressed the remaining provision regarding gender-affirming care.