The Supreme Court on June 30 threw out several lower court rulings, directing judges to take a second look at their decisions in light of a recent ruling that upheld Tennessee’s ban on transgender procedures for minors.
Three of the cases—from West Virginia, North Carolina, and Idaho—concern whether a state may exclude transgender surgeries from coverage under various health insurance plans. A fourth case concerns whether Oklahoma is violating the U.S. Constitution by requiring that birth certificates reflect a person’s sex at birth.
The new orders were announced on the court’s order list.
On June 18, the Supreme Court upheld Tennessee’s ban on providing such interventions as cross-sex hormones and puberty blockers for minors experiencing gender dysphoria.
In a 6–3 decision, the nation’s highest court disagreed with the Biden administration’s argument that the law should face higher legal scrutiny than had been applied by an appeals court.
The June 18 ruling came in a case known as United States v. Skrmetti. The respondent, Jonathan Skrmetti, is the attorney general of Tennessee.
Tennessee’s law, known as Senate Bill 1, forbids health care providers from administering puberty blockers or hormones for the purpose of “enabling a minor to identify with, or live as, a purported identity inconsistent with the minor’s sex” or “treating purported discomfort or distress from a discordance between the minor’s sex and asserted identity.”
It also contains a provision banning surgical procedures, such as those altering minors’ organs, but that portion of the legislation was not at issue by the time the Supreme Court reviewed the case.
On June 30, in Crouch v. Anderson and Folwell v. Kadel, the Supreme Court vacated judgments issued by the U.S. Court of Appeals for the Fourth Circuit and sent the cases back to that court for reconsideration in the wake of the Skrmetti decision.
Lawyers call this process, which disposes of cases without holding an oral argument, GVR, for grant, vacate, and remand.
In the Crouch case, West Virginia, “one of America’s poorest States,” limited Medicaid coverage for “‘transsexual surgery,’ which … refers to surgery intended to treat gender dysphoria,” according to the state’s petition.
Medicaid is a joint federal–state program that offers health insurance coverage to low-income Americans. The program is governed by the federal Medicaid Act.
The cost of the surgeries can run to tens of thousands of dollars, “not even including the treatments that precede securing approval for them or the life-long hormone treatments that follow,” according to the petition.
“So, like many other programs (federal, state, and private alike), West Virginia Medicaid excluded them,” the petition said.
A divided Fourth Circuit found that the state’s decision to not cover surgeries violated the Constitution’s equal protection clause.
In the Folwell case, at issue was the decision of the North Carolina State Health Plan for Teachers and State Employees to not cover treatments “leading to or in connection with sex changes or modifications,” the state’s petition said.
“[The coverage exclusion] is one of many in the Plan, which also excludes coverage for cosmetic services, experimental treatments, surgery for psychological or emotional reasons, and more,” the petition reads. “Each of those choices is designed to ensure that the Plan can provide the best possible coverage for all 740,000 of its members at a reasonable cost.”
The Fourth Circuit held that the plan’s exclusion of coverage for transgender treatments ran afoul of the equal protection clause, and the court issued a permanent injunction blocking it.
In Hamso v. M.H., Idaho’s Medicaid program declined to cover transgender surgeries. The state was sued by patients who argued that the coverage exclusion provided in state law violated the equal protection clause, according to Idaho’s petition. The U.S. Court of Appeals for the Ninth Circuit ruled against the state.
The petition said the Supreme Court could hold off on deciding on the petition until after the Skrmetti ruling because the case is concerned with “a question nearly indistinguishable from the one in Skrmetti.”
On June 30, the Supreme Court directed the Ninth Circuit to reconsider its ruling in Hamso v. M.H. in light of the Skrmetti decision.
In Stitt v. Fowler, Oklahoma had asked the Supreme Court to validate the state’s policy of requiring that birth certificates reflect a person’s biological sex at birth, as opposed to gender identity.
A federal district court ruled for the state and dismissed a lawsuit brought by transgender-identifying individuals who wanted their birth certificates to reflect their gender identity and whose request to amend the documents was denied. The U.S. Court of Appeals for the 10th Circuit reversed the decision in part, ruling that the individuals could proceed with an equal protection claim, the state’s petition said.
On June 30, the Supreme Court vacated the 10th Circuit’s ruling and directed that court to take another look at the case in the wake of the Skrmetti decision.
Sam Dorman contributed to this report.
This article by Matthew Vadum appeared June 30, 2025, in The Epoch Times. It was updated July 1, 2025.