gender reassignment surgery tax deductible

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• Same Sex Tax

The IRS Agrees: Gender Reassignment Surgery Is a Deductible Medical Expense

Are the expenses incurred for gender reassignement surgery deductible medical expenses under §213 of the Internal Revenue Code or are they nondeductible expenses for cosmetic surgery? Rhiannon O’Donnabhain thought so and so she deducted them in 2001. The IRS denied the deduction and she sued in Tax Court. The Tax Court ruled in her favor in 2010 and now the IRS has acquiesced in that decision.

The IRS issues an acquiescence when it agrees with a decision by the Tax Court. This is essentially the equivalent of a revenue ruling saying that such expenses are deductible. For a copy of the AOD (Action on Decision) see here .  

O’Donnabhain incurred her costs in 2001 and deducted them on her 2001 tax return. She received her tax refund and in 2002 she was audited. GLAD tells us that the local IRS folks were at first inclined to allow the deduction, but for them it was an issue of first impression and so they sought guidance from the National Office – sometimes we call this a request for technical advice or a field service advisory – but more and more in recent days this advice is published as Advice from Chief Counsel – a CCA – and that’s what ultimately led to the tax court battle in this case.

But if you do a little detective work, you’ll find that the initial response from the Office of Chief Counsel was supportive of the deduction. In 2003, about the time that this case was in audit, a PLR was issued (PLR 200324011). It was carefully worded so as not to attract attention. It simply provided the following information:The taxpayer has been diagnosed with an unidentified disorder and is planning to undergo an unidentified surgical procedure.

That ruling concluded that because the proposed surgery would affect a “structure or function of the body” it should qualify as medical care under §213. The IRS also noted that the pproposed surgery was not directed primarily at improving the taxpayer’s appearance and so was not a cosmetic procedure.

That was written by staffers in office of Chief Counsel who wanted to get the law right. But I’m told that the then Commissioner got whiff of the proposed advice and demanded a different result, citing Bush family values as his guide. And the result was the CCA denying the deduction and leading to this litigation.

Cookies in use

Transgender-inclusive benefits: taxability of related medical expenses.

On February 2, 2010, the U.S. Tax Court issued an important decision in O'Donnabhain v. Commissioner of Internal Revenue , ruling for the first time that necessary treatment for gender identity disorder qualifies as medical care under the Internal Revenue Code, and therefore costs related to that care are deductible from federal income taxes.

The court ruled that sex reassignment surgeries qualify as deductible medical expenses under IRS code § 213, reversing a previous IRS position that had denied transgender people the ability to list expenses for medical services related to sex reassignment as tax deductions. The ruling holds that gender identity disorder is considered a "disease" within the meaning of § 213(d)(1)(A) & (9)(B) and that hormone therapy and sex reassignment surgeries are recognized treatments for disease within the meaning of § 213(d)(1)(A) & (9)(B), and thus not "cosmetic surgery" excluded from the definition of deductible "medical care" by § 213(d)(9)(A).

While the court did not allow Ms. O’Donnabhain to deduct the costs of her breast augmentation, the opinion recognized that breast augmentation is considered a sex reassignment surgery in certain cases and would be deductible for other transgender people with supporting medical documentation -- a finding that closely aligns with the WPATH Standards of Care.

This ruling should encourage employers to treat coverage for medically necessary transgender treatment (treatment that follows the WPATH SOC) no differently than other medically necessary treatments for tax purposes. Notably, the IRS did not appeal the Tax Court’s decision. Employers and individuals should consult with a tax expert, such as a CPA or tax attorney.

• In re Rhiannon O'Donnabhain
• United States Tax Court: In re Rhiannan O'Donnabhain (PDF) Feb. 2, 2010

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Tax Court Allows Medical Deduction for Sex Change Operation

• Individual Income Taxation
• Specialized Issues

In a case of first impression, the Tax Court has held that a taxpayer can take a medical expense deduction for the costs of her sex change operation ( O’Donnabhain , 134 T.C. No. 10). However, the Tax Court disallowed the taxpayer’s expenses for breast augmentation surgery as cosmetic surgery.

The taxpayer was born male but was diagnosed with gender identity disorder. As a result of this condition, the taxpayer suffered persistent psychological discomfort with her gender. In a three-part treatment regimen, the taxpayer took feminizing hormones from 1997 through 2001, began presenting herself as a female in public starting in 2000, and underwent gender reassignment surgery (including breast augmentation) in 2001. For tax year 2001, the taxpayer claimed a $21,741 deduction for the costs of the feminizing hormones, the surgeries, and transportation and other related expenses. The IRS disallowed the deduction.

Sec. 213 allows taxpayers to deduct the costs of medical care paid during a tax year to the extent they exceed 7.5% of the taxpayer’s adjusted gross income (and if they are not reimbursed by insurance). The Tax Court reviewed the definition of medical care, which under Sec. 213(d)(1)(A) has two prongs:(1) amounts paidfor the “diagnosis, cure, mitigation,treatment, orpreventionof disease” and (2) amounts paid “for the purpose of affecting any structure or function of the body.” The court noted that it has long been settled law that “disease” for these purposes includes mental disorders. The court also noted that, under Sec. 213(d) (9), cosmetic surgery is specifically excluded from the definition of medical care.

In disallowing the deduction, the IRS argued that the taxpayer’s hormone therapy, sex reassignment surgery, and breast augmentation surgery all qualified as cosmetic surgery. The IRS maintained that these procedures were directed at improving the taxpayer’s appearance and not treatment for an illness or disease. Although the IRS conceded that gender identity disorder is a mental disorder, it argued that it is not a disease because it does not “arise from an organic pathology within the human body.” The IRS further argued that there was no evidence that procedures the taxpayer underwent were effective in treating gender identity disorder.

The Tax Court reviewed medical literature and prior case law to come to the conclusion that gender identity disorder is a disease for purposes of Sec. 213. The court rejected the IRS’s position that to qualify as a disease under Sec. 213, a condition must have a demonstrated organic origin. The court determined that the taxpayer suffered significant impairment from the disease. Finally, the court also concluded that the taxpayer’s three-part treatment regimen, culminating in sex reassignment surgery, was generally accepted by the medical community (and by the experts who testified in the case) as effective treatment for gender identity disorder.

The court held that as treatment for a disease, the hormone therapy and sex reassignment surgery were not cosmetic surgery. However, it also held that the taxpayer’s breast augmentation surgery was cosmetic because it was directed at improving her appearance and did not promote proper function of the body or treat disease.

The court allowed the taxpayer’s deductions for the costs of the hormone therapy and the sex reassignment surgery as costs for medical care under Sec. 213 and disallowed the deduction for the cost of the breast augmentation surgery.

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Transgender Woman, IRS Fight over Tax Deduction

Tovia Smith

Rhiannon O'Donnabhain says she spent more than $25,000 on sex-reassignment surgery in 2001, and claimed a $5,000 deduction she says she is entitled to. But the IRS denied the deduction, saying it was for cosmetic purposes. Maineframe Photographics, Inc. hide caption

Rhiannon O'Donnabhain says she spent more than $25,000 on sex-reassignment surgery in 2001, and claimed a $5,000 deduction she says she is entitled to. But the IRS denied the deduction, saying it was for cosmetic purposes.

A Massachusetts transgender woman is suing the IRS for the right to claim her sex-change operation as a medical deduction on her income taxes.

Rhiannon O'Donnabhain says she spent more than $25,000 on sex-reassignment surgery in 2001, and claimed a $5,000 deduction she was entitled to. But the IRS denied the deduction, saying the surgery was essentially cosmetic and therefore not allowed under tax law. The case is now before a federal judge in Boston.

Changing a Troubled Life

In the trial that began in July, O'Donnabhain, 64, described a lifetime of suffering from Gender Identity Disorder, or GID. She says she never had the words for it as a child, but she always felt that she was born into the wrong body.

She described growing up as a young boy, in a conservative, Catholic family and trying to suppress the feelings. She played with boys, worked in construction, married a woman and fathered three children. But O'Donnabhain says she grew increasingly tormented.

"It was horrible. Absolutely horrible. I was thinking suicide was probably the only way out of this," she said.

Eventually, O'Donnabhain started therapy and began the transition to life as a female. She changed her name, started dressing like a woman and took feminizing hormones to change her body. But O'Donnabhain says it wasn't enough. "I was a male with breasts. I looked like a freak."

In 2001, O'Donnabhain underwent sex-change surgery. She had her male genitals removed and received every procedure doctors provided to give her a female body — from vaginal reconstruction to breast augmentation. For the first time in her life, O'Donnabhain says she felt at peace.

"I'm just so glad I did this," she said.

Battling the IRS

While O'Donnabhain believes her sex-change operation literally saved her life, the IRS argues that it falls into the category of "cosmetic surgery" under its tax code and is not allowed as a deduction. Agency officials declined to be interviewed for this story, but in court they argued that sex-reassignment surgery deals with the body's appearance more than function, and that GID is not a "disease" or "illness" as defined by tax laws.

"The IRS is arguing that gender-reassignment surgery is really no different, conceptually, than a tummy tuck or a Botox injection," said Theodore Seto, a professor at Loyola Law School, Los Angeles. "The argument is: 'Look, she is changing her appearance so as to look better, to be happier with herself. It doesn't treat any underlying problem.'"

But O'Donnabhain accused the IRS of discrimination. She said her surgery was meant to treat a legitimate and widely recognized medical condition.

"It's really astonishing that the IRS is taking a position that they get to second-guess the determinations of a taxpayer's medical care providers," said O'Donnabhain's attorney, Karen Loewy. "The medical community gets to decide what is medical care — not the IRS."

But the IRS counters that the medical community is split. While some see sex-reassignment surgery as the closest thing medicine has to a cure for GID, others see the surgery as basically mutilating a person's properly functioning anatomy.

"I think the problem doesn't lie in their genitals, it lies in their mind, and we should be working on their mind," says Paul McHugh, a professor of psychiatry at Johns Hopkins University. "We don't do liposuction on people with anorexia nervosa to help them to be more thin. We encourage them to see that this is a misdirection of human interest."

But O'Donnabhain points out that even the therapy she sought for her GID was rejected by the IRS as a medical expense, proving the agency's bias.

A Growing Number of Cases

O'Donnabhain's case is the latest in a growing number of legal tangles over transgender rights. Courts around the nation are grappling with a slew of lawsuits — from prisoners demanding sex-change hormones as part of their medical care and kindergarteners asking to be called "she" instead of "he," to transsexuals seeking to marry or use the public restroom of their new gender.

"There has been an incredible amount of litigation, but the law is all over the place," said Arthur Leonard, a professor at New York Law School. "It all comes down to the sort of fundamental question of whether the law will accept what transgender people say is their reality. And that requires us to rethink our concept of a dimorphic world where everything is 'x' and 'y.' Here's something that's sort of in the middle."

Ultimately, the transgender community faces an irony that is not lost on O'Donnabhain. That is, the fight to be legally accepted and accommodated by the IRS actually depends on being seen as pathologically diseased or ill.

"It's a Catch-22," O'Donnabhain said. "I have to accept the stigma of being labeled as having a disorder [or] a mental condition ... in order to get benefits. I haven't liked this diagnosis from the very beginning. But I've got to play the game."

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Deductible Cosmetic Surgery and the Treatment of Transgenderism: An Analysis of the Medical Expense Deduction Post-O’Donnabhain

2012 American Taxation Association Midyear Meeting: JLTR Conference

32 Pages Posted: 13 Feb 2012

Weber State University (WSU)

Ryan H. Pace

Date Written: February 2012

In 2010, the United States Tax Court upheld a taxpayer’s deduction for medical expenses arising from gender-reassignment surgery. This article discusses the facts of the O’Donnabhain case and the Tax Court’s holding in light of relevant legislative history, and finds that a new layer of understanding now exists in the context of deductible cosmetic surgery: in a post-O’Donnabhain world, mental (not just physical) diseases may be treated through physical alterations to the body which constitute deductible cosmetic surgery. Based on the Tax Court’s opinion, we posit an algorithm for application of what we consider a fourth case-law created exception to the disallowance of deductions for cosmetic surgery.

Keywords: deductible medical expenses, cosmetic surgery, gender confusion

Suggested Citation: Suggested Citation

Eric Steven Smith (Contact Author)

Weber state university (wsu) ( email ).

1337 Edvalson Dept 3803 Ogden, UT 84408 United States (801) 626-6041 (Phone)

3802 University Circle Ogden, UT 84408 United States

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Will caitlyn jenner's gender reassignment costs be tax deductible.

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Unless you've been living in a cave, in the nether regions of a remote mountain range, that happens to be located on the dark side of the moon, you're well aware that former Olympic gold medalist Bruce Jenner has publicly transitioned into a woman named Caitlyn.

The rumored transition had been tabloid fodder for years, but Jenner removed all doubt last month when she sat down for an interview with Diane Sawyer in which she explained that she has struggled with Gender Identity Disorder (GID) since she was a child, announcing, "I am a woman."

Jennner instantly became the most well-known transgender individual on the planet, but questions remained after the interview regarding the e xtent to which Jenner has transitioned. Those questions were largely answered in a subsequent article published in Vanity Fair -- which featured Jenner as a woman on the cover --  in which it was revealed that while she has undergone breast augmentation, facial feminization cosmetic surgery, and hormone treatment, she has not yet undergone a full genital transition.

While Jenner has no shortage of available cash courtesy of her successful athletic career and the many *cough cough* talents of the reality-star Kardashian kin, a full genital transition, should she undergo one, will be an expensive proposition. This raises an interesting question:

Can Jenner deduct the costs of the gender reassignment process as a medical expense?

Let's take a look.

Gender Reassignment, In General

GID is listed in the Diagnostic and Statistical Manual of Mental Disorders ( DSM -IVTR), published by the American Psychiatric Association. The DSMIV- TR states that a diagnosis of GID is indicated where an individual exhibits (1) a strong and persistent desire to be, or belief that he or she is, the other sex; (2) persistent discomfort with his or her anatomical sex, including a preoccupation with getting rid of primary or secondary sex characteristics; (3) an absence of any physical intersex (hermaphroditic) condition; and (4) clinically significant distress or impairment in social, occupational, or other important areas of functioning as a result of the discomfort arising from the perceived incongruence between anatomical sex and perceived gender identity.

Once an individual has been diagnosed with GID by a licensed psychotherapist, the patient typically undergoes treatment as prescribed by the World Professional Association for Transgender Health (WPATH) — formerly known as the Harry Benjamin International Gender Dysphoria Association, Inc.

The so-called “Benjamin standards” follow a three-step approach to gender reassignment. First, the patient undergoes hormonal sex reassignment; i.e., the administration of cross-gender hormones to effect changes in physical appearance to more closely resemble the opposite sex. Next , the patient must go through the “real-life” experience, wherein the individual undertakes a trial period of living full time in society as a member of the opposite sex. Once the “real-life” experience is complete, a patient may undergo sex reassignment surgery, consisting of genital sex reassignment and/or nongenital sex reassignment.

Genital surgical sex reassignment refers to surgery of the genitalia and/or breasts performed for the purpose of altering the morphology in order to approximate the physical appearance of the genetically other sex in persons diagnosed as gender dysphoric. Specific to breast augmentation, the standards provide that the standards provide that surgery may be performed as part of sex reassignment surgery for a male-to-female patient “if the physician prescribing hormones and the surgeon have documented that breast enlargement after undergoing hormone treatment for 18 months is not sufficient for comfort in the social gender role.”

To the contrary, non-genital surgical sex reassignment refers to any and all other surgical procedures of non-genital, or non-breast, sites (nose, throat, chin, cheeks, hips, etc.) conducted for the purpose of effecting a more masculine appearance in a genetic female or for the purpose of effecting a more feminine appearance in a genetic male in the absence of identifiable pathology which would warrant such surgery regardless of the patient’s genetic sex (facial injuries, hermaphroditism, etc.).

As you can see, this is bit more involved than Willem Dafoe throwing on a wig and high heels in Boondock Saints. Gender reassignment is a long, thorough, and yes, expensive process. But is it tax deductible?

Medical Expense Deduction, In General

Section 213(a) allows a deduction for expenses paid during the taxable year for medical care that are not compensated for by insurance or otherwise and to the extent that such expenses exceed 10 percent of adjusted gross income (7.5% if the taxpayer is 65 or older at the end of the tax year).

The core definition of “medical care” originally set forth in section 23(x) of the 1939 Code has endured over time and is currently found in section 213(d)(1)(A), which provides as follows:

The term “medical care” means amounts paid for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body.

The regulations then clarify that a “disease” includes a mental disorder:

Deductions for expenditures for medical care allowable under section 213 will be confined strictly to expenses incurred primarily for the prevention or alleviation of a physical or mental defect or illness. [Sec. 1.213-1(e)(1)]

In 1990, Congress amended Section 213 to include new subsection (d)(9) which excludes cosmetic surgery from the definition of deductible medical care.

Section 213(d)(9)(B) defines cosmetic surgery as “any procedure which is directed at improving the patient’s appearance and does not meaningfully promote the proper function of the body or prevent or treat illness or disease.”

Medical Expense Deduction for Gender Reassignment

Pursuant to Section 213, in order for a taxpayer to be permitted to deduct the cost of hormone treatment and gender reassignment surgery, three tests must be satisfied:

1. GID must be recognized as a “disease” for purposes of Section 213,

2. The hormone treatment and gender reassignment surgery must “treat” that disease, and

3. The surgery must not be cosmetic in nature.

In 2006, the IRS published CCA 200603025, which concluded that costs for gender reassignment were not deductible, because they were cosmetic in nature and not for the treatment of a disease. The taxpayer who was the subject of that CCA eventually went to trial, and in 2010, in a case of first impression, the Tax Court settled the tax treatment of gender reassignment costs in O’Donnabhain v. Commissioner , 134 T.C. 34 (2010).

In O’Donnabhain , the taxpayer was born a male, but believed early on that he was meant to live as a woman. After 20 years of marriage and fathering three children, he divorced and sought treatment for his disorder. He was diagnosed with GID, and subsequently went through the Benjamin standards.

In 2001, the taxpayer deducted costs for his hormone treatment and sex reassignment surgery, which included breast augmentation. The IRS denied the deduction, adhering to the position stated in CCA 200603025 that the costs did not treat a disease and that the surgery was cosmetic in nature.

The Tax Court, however, reached three very important conclusions:

1. Gender identity disorder is a disease within the meaning of Section 213(d)(1)(A) and (9)(B). In reaching its decision, the court cited (1) GID’s widely recognized status in diagnostic and psychiatric reference texts as a legitimate diagnosis, (2) the seriousness of the condition as described in learned treatises in evidence and as acknowledged by all three experts in this case, (3) the severity of petitioner’s impairment as found by the mental health professionals who examined her; and (4) the consensus in the U.S. Courts of Appeal that GID constitutes a serious medical need for purposes of the Eighth Amendment.

2. Hormone treatment and gender reassignment surgery were for the “treatment” of the disease within the meaning of Sections 213(d)(1)(A) and (9)(B), and thus were not cosmetic in nature. The court reached this conclusion in large part because hormone treatment and sex reassignment surgery are prescribed therapeutic interventions for GID as outlined in the Benjamin standards. In fact, according to an expert witness, sex reassignment surgery is the “only known effective treatment.”

3. Because the taxpayer’s breasts were deemed satisfactory by the patient’s doctor after the hormone treatment, the further surgery to augment the breasts was cosmetic in nature, because it did not treat the taxpayer’s GID, but rather merely improved her appearance.

In November 2011, the IRS acquiesced on O’Donnabhain , abandoning its position stated in CCA 20063025. Thus, Caitlyn Jenner faces a much more friendly tax environment than the one that existed as recently as four years ago. It appears that Jenner is following the Benjamin standards, with the Vanity Fair cover signifying the beginning of Stage 2, in which she will live publicly as a woman for a prescribed period of time before she undergoes full genital reassignment.

Assuming Jenner has been formally diagnosed with GID and is indeed following the prescribed standards, because GID is now recognized as a disease for purposes of the Code, the cost of treatment, including hormone therapy and sex reassignment surgery, should generally be respected as a deductible medical expense. Certain costs deemed purely cosmetic -- rather than as treating the underlying GID -- such as any additional breast augmentation above and beyond what is deemed necessary after Jenner's hormone treatment, or alterations to her hairline, forehead, jaw and chin will likely be denied under the principles established in CCA 200603025 and O'Donnabhain, though neither authority addressed the facial surgeries directly.

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Tax Court Allows Medical Deduction for Sex Change Operation

• Individual Income Taxation

In a case of first impression, the Tax Court has held that a taxpayer can take a medical expense deduction for the costs of a sex change operation ( O’Donnabhain , 134 TC no. 4). However, the taxpayer’s expenses for breast augmentation surgery were disallowed by the court as cosmetic surgery.

The taxpayer was born male, but diagnosed with gender identity disorder. As a result of this condition, the taxpayer suffered persistent psychological discomfort with her gender. As part of a three-part treatment regimen, the taxpayer took feminizing hormones from 1997 through 2001, began presenting herself as a female in public starting in 2000, and underwent gender reassignment surgery (including breast augmentation) in 2001. For tax year 2001, the taxpayer claimed a $21,741 deduction for the costs of the feminizing hormones, surgeries, and transportation and other related expenses. The IRS disallowed the deduction.

IRC § 213 allows taxpayers to deduct the costs of medical care paid during a tax year to the extent they exceed 7.5% of the taxpayer’s adjusted gross income (and if they are not reimbursed by insurance). The Tax Court reviewed the definition of medical care, which under section 213(d)(1)(A) has two prongs: (1) amounts paid for the “diagnosis, cure, mitigation, treatment, or prevention of disease” and (2) amounts paid “for the purpose of affecting any structure or function of the body.” The court noted that it has long been settled law that “disease” for these purposes includes mental disorders. The court also noted that, under section 213(d)(9), cosmetic surgery is specifically excluded from the definition of medical care.

In disallowing the deduction, the IRS argued that the taxpayer’s hormone therapy, sex reassignment surgery and breast augmentation surgery all qualified as cosmetic surgery. The IRS maintained that these procedures were directed at improving the taxpayer’s appearance and not treating an illness or disease. Although the IRS conceded that gender identity disorder is a mental disorder, it argued that it is not a disease because it does not “arise from an organic pathology within the human body.” The IRS further argued that there was no evidence that procedures the taxpayer underwent were effective in treating gender identity disorder.

The Tax Court reviewed medical literature and prior case law to come to the conclusion that gender identify disorder is a disease for purposes of IRC § 213. The court rejected the IRS’ position that to qualify as a “disease” under section 213 a condition must have a demonstrated organic origin. The court also concluded that the taxpayer suffered significant impairment from the disease. Finally, the court concluded that the taxpayer’s three-part treatment regimen, culminating in sex reassignment surgery, was generally accepted by the medical community (and by the experts who testified in the case) as effective treatment for gender identity disorder.

The court held that as treatment for a disease, the hormone therapy and sex reassignment surgery were not cosmetic surgery and allowed the taxpayer’s deductions for those costs. However, the court disallowed the deduction for the taxpayer’s breast augmentation surgery because it was a cosmetic surgery directed at improving her appearance and did not promote proper function of the body or treat disease.

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Deducting the Cost of Sex Reassignment Surgery: How O’Donnabhain v. Commissioner Can Help Us Make Sense of the Medical Expense Deduction

• Tamar E. Luszti + −

How to Cite

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In February 2010, the Tax Court held that a taxpayer’s expenses incurred for hormone therapy and sex reassignment surgery were deductible as medical expenses under § 213 because they treated the disease of gender identity disorder. The court, however, was deeply divided in its determination of whether sex reassignment surgery qualifies as nondeductible cosmetic surgery under § 213(d)(9). In 1990, Congress amended § 213 to exclude cosmetic surgery from the definition of deductible medical care. Since then, the Tax Court and the I.R.S. have rarely addressed the meaning and extent of that exclusion. The judges’ divergent opinions in O’Donnabhain make it clear that a thorough examination of the statutory meaning of cosmetic surgery is timely.

This Note considers what should qualify as cosmetic surgery within the context of the medical expense deduction. It argues that a medical procedure that improves physical appearance should be deductible under § 213 when it is physician-prescribed treatment for a specific disease, and consistent with generally accepted medical practice. This analysis is grounded in the statutory language of § 213, and is supported by broader principles that bear on the policy debate surrounding the medical expense deduction more generally.

J.D. 2012, Columbia Law School

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Biden ‘gender reassignment’ surgery mandate blocked

By Peter Pinedo

Houston, Texas, Sep 3, 2024 / 16:45 pm

A U.S. district judge has placed a nationwide block on a Biden-Harris administration rule mandating that federally funded hospitals perform surgical interventions to alter the body’s appearance to mimic that of the opposite sex.

This comes after Texas and Montana sued the administration over changes it made in May to the Affordable Care Act’s section prohibiting discrimination based on sex.

The rule broadened the meaning of “sex” to include “gender identity.” This meant that federally funded hospitals were required to perform so-called “gender reassignment” surgeries or face a range of penalties including having their funding removed.

Texas and Montana argued that the change violated portions of state law that prohibit such surgical interventions performed on minors’ sexual and reproductive organs and ban Medicaid funding for these operations.

The two states argued that the Biden administration has given them “an impossible choice” to either “violate and abandon state law or risk devastating financial loss.”

The ruling, issued on Aug. 30 by Judge Jeremy Kernodle for the Eastern District of Texas, expanded an earlier court decision that blocked the mandate for hospitals in Texas and Montana. Kernodle said the Biden administration’s mandate is “unlawful” in all hospitals, not just those in Texas and Montana.

Texas Attorney General Ken Paxton called the ruling a “major victory for Americans across the country.”

“When Biden and Harris sidestep the Constitution to force their unlawful, extremist agenda on the American public, we are fighting back and stopping them,” Paxton said.

Jennifer Carr Allmon, executive director of the Texas Catholic Conference of Bishops, told CNA that the Texas bishops are “grateful” for the nationwide stay.  

Catholic experts respond to Pope Francis on repelling migrants being ‘a grave sin’

Allmon said that gender transition surgeries are “not authentic health care” because these procedures “interrupt natural developmental processes and can result in infertility and other serious health risks, especially for children, all of which may be irreversible.”

“Health care providers must be free to refuse to perform these harmful interventions without risk of penalty,” she said. “The Texas Catholic Conference of Bishops advocates for health care that is oriented toward honoring the dignity of each person while respecting the religious liberty and conscience rights of medical professionals.”

The Biden administration will likely appeal the ruling to the Fifth Circuit Appellate Court.

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