A federal judge in Massachusetts has struck down a Trump administration rule that would have excluded certain gender-affirming care from the Affordable Care Act's essential health benefits, California Attorney General Rob Bonta announced Saturday.
Bonta, who co-led a multistate coalition with the attorneys general of Massachusetts and New Jersey, said the ruling preserves access to financial protections under the ACA, including limits on out-of-pocket costs, for covered gender-affirming care.
The case challenged the administration's "Marketplace Integrity and Affordability" rule, which was proposed in March 2025, according to a press release.
The rule sought to remove certain gender-affirming treatments from the ACA's 10 essential health benefit categories as part of broader efforts to curb alleged enrollment fraud and reduce federal spending on subsidies.
The coalition sued in July 2025, arguing the rule would make ACA coverage harder to obtain, increase costs for states, and weaken key ACA protections.
The U.S. District Court for the District of Massachusetts ruled the administration unlawfully changed the essential health benefit categories without following procedures required by the ACA, the AG's Office said.
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