Health Law Daily Wrap Up, HEALTH CARE REFORM—11th Cir.: Vacatur of HHS gender-identity provisions moots Florida challenge, (Sep 10, 2026)

By WK Editorial Staff

The Eleventh Circuit dismissed the appeal because a separate, unappealed ruling had already voided every provision of the 2024 rule challenged in the case.

The Eleventh Circuit dismissed Florida's appeal challenging HHS's 2024 nondiscrimination rule, holding that later developments left no live controversy for the court to decide. A federal district court in a separate case had universally vacated the rule's provisions expanding sex discrimination to include gender-identity discrimination, and HHS had announced that it could not and would not enforce those provisions. Because the challenged provisions were void and had never been applied to the challengers, the court concluded that no form of requested relief could change their legal position (State of Florida v. HHS, No. 25-12095 (11th Cir. Sept. 4, 2026)).

The 2024 rule implemented section 1557 of the Affordable Care Act, which prohibits discrimination prohibited by Title IX in certain federally funded and federally administered health programs and activities. The rule defined sex discrimination to include discrimination based on gender identity and restricted when covered entities could deny or limit health services or coverage related to gender transition or other gender-affirming care. It also required nondiscrimination policies and notices and amended CMS regulations governing Medicaid and CHIP managed care contracts, culturally competent care, and Program of All-Inclusive Care for the Elderly organizations.

Florida, two state agencies, and a medical association challenged portions of the rule under the Administrative Procedure Act. They argued that HHS exceeded its statutory authority by treating gender-identity discrimination as sex discrimination, regulating policies with discriminatory effects, and imposing conditions that Congress had not stated unambiguously under the Spending Clause. The medical association also asserted free-speech, free-exercise, and Religious Freedom Restoration Act claims. The challengers sought vacatur, an injunction against enforcement, and declarations limiting HHS's authority to apply the rule.

Before the challenged provisions took effect, the district court postponed their effective date in Florida and enjoined enforcement against covered entities in the state. After the presidential administration changed, the district court dismissed the case as moot. The challengers appealed, arguing that executive orders announcing new federal policies had not themselves rescinded or amended the regulations and therefore had not eliminated the dispute.

The appellate court did not decide whether the district court's original mootness ruling was correct. Instead, it relied on events that occurred while the appeal was pending. In a separate challenge brought by other states, a federal district court held that HHS exceeded its authority by expanding sex discrimination to include gender-identity discrimination. Applying the rule's severability provision, that court vacated the provisions addressing gender identity and gender-affirming care, including the provisions challenged in Florida's case. HHS did not appeal that judgment.

The Eleventh Circuit explained that vacatur is the ordinary APA remedy and renders an agency action legally ineffective. The separate judgment therefore nullified and revoked the challenged provisions, rather than merely preventing their enforcement against the parties in that case. HHS later issued a notice stating that the vacated provisions were legally void and that its Office for Civil Rights could not and would not investigate or enforce compliance with them.

Those developments made meaningful relief impossible, the court held. A favorable decision on the APA claims would leave the challengers in the same position because the provisions they sought to set aside were already void. Their request for an injunction also became moot because the vacatur eliminated a cognizable risk of future enforcement. The request for declaratory relief failed for the same reason: after vacatur, no dispute concerning the challenged provisions had sufficient immediacy to support a declaration.

The court rejected the argument that the challengers' constitutional and statutory claims preserved the case. Although the separate court had not resolved the Spending Clause, First Amendment, or Religious Freedom Restoration Act theories, those claims targeted provisions that never took effect against the challengers and no longer had legal force. Addressing those theories would not affect the parties' rights and would amount to an advisory opinion.

The court also declined to consider a challenge to the rule's treatment of sex stereotypes. The complaint mentioned that aspect of the rule but did not identify it as a challenged provision, and the court would not consider a new claim raised for the first time on appeal. Because all claims properly before the court were moot, the Eleventh Circuit dismissed the appeal without vacating or remanding the district court's judgment, which had already dismissed the case as moot.

The case is No. 25-12095.

Judge: Per curiam.

Attorneys: Allen Huang, U.S. Department of Justice, for State of Florida. James Conde (Boyden Gray, PLLC) for Florida Agency for Health Care Administration and Florida Department of Management Services. Ashley Cheung Honold, U.S. Department of Justice, for Department of Health and Human Services.

Companies: State of Florida; Florida Agency for Health Care Administration; Florida Department of Management Services; Department of Health and Human Services

Cases: CaseDecisions CMSNews HealthReformNews AlabamaNews FloridaNews GeorgiaNews