Supreme Court Upholds Tennessee Ban on Gender-Affirming Care

Today, the U.S. Supreme Court issued a 6–3 ruling in U.S. v. Skrmetti, upholding Tennessee’s ban on puberty blockers and hormone therapy for minors. Chief Justice Roberts ruled that such restrictions do not violate the 14th Amendment’s equal protection clause, placing the decision squarely in the realm of state legislatures.

The precedent shields similar bans in approximately two dozen states, reinforcing state-level authority over such healthcare decisions. Justice Sotomayor’s dissent warned of “untold harm” to transgender youth if access to evidence-based care is blocked. This opinion is backed by major medical bodies—including the AMA, APA, and AAP—continue to endorse gender-affirming care as safe and necessary, emphasizing ongoing conflict between law and clinical best practices.

The Skrmetti ruling solidifies state authority to restrict gender-affirming care, emboldening new bans and reinforcing existing ones. Hospitals must proactively assess legal risks, adjust service models, align with best-practice referral networks, and prepare for intensified federal scrutiny. Coordinated advocacy and adaptive care strategies will be essential to continue delivering safe, patient-centered care in this volatile policy environment.

 

What This Means for Hospitals & Health Systems

  1. Expanded State-Level Risk
    Hospitals operating in or serving patients from states with bans face heightened exposure—including legal, licensing, or insurance risks—for offering care now deemed impermissible by law. Providers must carefully audit care pathways and risk scenarios.
  2. Patient Migration and Capacity Strain
    Families may increasingly travel to non-ban states for care, placing added pressure on clinician capacity, Medicaid coverage, and care coordination at out-of-state facilities.
  3. Urgent Compliance Planning
    While the Court focused on constitutional authority, federal actions under Trump (EO 14187) threaten to withdraw funding from institutions offering care—raising compliance questions even without explicit bans.

 

What’s Next: Trump Administration Moves

  • Executive Order 14187 (Jan 28, 2025):
    Prohibits federal funding/support for gender-affirming treatments to anyone under 19, mandates DOJ investigations of providers and manufacturers, and even urged CMS to restrict Medicaid coverage.
  • Legal Pushback & Mixed Implementation:
    Multiple federal injunctions have temporarily blocked aspects of the EO, allowing some hospitals to resume care, though others paused indefinitely amid uncertainty.
  • Next Moves Expected:
    • DOJ enforcement actions targeting providers as per EO.
    • HHS interpretive guidance aimed at Medicaid, Medicare, ACA‑funded programs.
    • CMS encouragement (though not mandates) pushing states to bar Medicaid for minors.

 

Recommended Actions for Health System Leaders

  1. Legal Risk & Compliance Audit
    • Identify which services or providers may be impacted by both state bans and federal funding threats. Engage legal counsel to analyze regulation status, pending injunctions, and board responsibilities.
  2. Strengthen Access & Referral Pathways
    • Coordinate with providers in protective states to support patient migration. Prepare telehealth and support services to reduce care delays and maintain continuity.
  3. Advocacy & Coalition Building
    • Join or reinforce state–hospital coalitions to defend gender-affirming care. Engage with state AGs issuing defensive amicus briefs and push for private insurer coverage independent of federal funding.
  4. Host Internal Strategy Sessions
    • Convene executives, compliance, clinical leads, and risk officers to create contingency plans:
      • Define jurisdiction-specific policies
      • Establish protocols for remote referrals
      • Plan for potential DOJ inquiries, and possible CMS funding disruptions
  5. Communications Preparedness
    • Develop messaging for staff, patients, and public on your commitment to adhering to best medical practices—even amid legal shifts. Be transparent about evolving legal landscapes and safety measures.