Overview

• The Eleventh Circuit’s en banc majority reversed prior decisions that had found Houston County’s exclusion unlawful, undoing a 2022 district-court judgment and a 2024 panel affirmance.
• The court held the plan is not facially discriminatory because it excludes gender-affirming surgery for all enrollees, reasoning that the policy draws treatment-based lines rather than classifications based on sex or transgender status.
• Relying on United States v. Skrmetti, the majority said neither it nor the Supreme Court has recognized transgender status as a separate Title VII category and that Bostock did not add such a category.
• The ruling produced eight opinions across 108 pages, including concurrences that questioned Skrmetti’s fit with Title VII and dissents arguing the exclusion denies medically necessary care and reflects sex-based discrimination.
• The decision is controlling within Georgia, Florida, and Alabama and sends Lange’s Title VII claim to trial to prove that the county’s policy constitutes unlawful discrimination.