DELAWARE - Attorney General Kathy Jennings announced a court victory protecting access to gender-affirming care under the Affordable Care Act.
The Delaware Department of Justice says the U.S. District Court for the District of Massachusetts struck down a provision of a Trump administration final rule that would have excluded certain types of gender-affirming care from the Affordable Care Act’s essential health benefit categories.
Essential health benefits are subject to the ACA’s financial protections, including limits on out-of-pocket costs.
The rule, known as the "Marketplace Integrity and Affordability" rule, was proposed by the Trump administration in March 2025. It was intended 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, the DOJ says Jennings and a coalition filed a lawsuit challenging nine provisions of the final rule. The coalition argued the provisions would make it harder for consumers to obtain coverage through the ACA, increase costs for states and weaken key ACA protections.
"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," Jennings said. "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 DOJ says seven of the provisions were later vacated in separate litigation in the U.S. District Court for the District of Maryland.
The Massachusetts court ruled that the Trump administration unlawfully modified the categories of essential health benefits without following the proper procedures required by the ACA, according to the DOJ.
