JACKSON, Mississippi (AP) — A federal district court judge on Wednesday temporarily halted parts of a nondiscrimination rule that would have kept insurers and medical professionals from denying hormone therapy, gender transition surgeries and similar medical care for transgender people.

U.S. District Judge Louis Guirola Jr. sided with 15 states that had argued the language the rule was based on — the 1972 Title IX nondiscrimination law — encompasses biological sex, but not gender identity. Guirola’s injunction applies nationwide to the Affordable Care Act rule, which would have gone into effect Friday.

It’s another blow to the Biden administration’s efforts to expand anti-discrimination protections. In the past few weeks, three federal judges have blocked a rule in several states that would protect LGBTQ+ students by expanding the definition of sexual harassment at schools and colleges under Title IX.

Health care protections based on gender identity had been added under the Obama administration and removed under former President Donald Trump. Earlier this year, the Department of Health and Human Services again broadened the scope of the Affordable Care Act rule to include discrimination based on “sex stereotypes, sexual orientation, gender identity and sex characteristics.”

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But the Republican attorneys general in Tennessee and the other states — mostly in the South and Midwest — argued the states would face financial burdens if they followed the new rule under Medicaid or other federal health programs or lose federal funding if they didn’t follow the rule. The plaintiffs also argued the rule was based on the federal agency’s “commitment to gender ideology over medical reality.”

During testimony, an attorney for the Mississippi Division of Medicaid, Cody Smith, testified that the agency is barred from covering gender transition procedures for children under 18 — which are uncommon — and that the state’s Medicaid program and Children’s Health Insurance Program doesn’t cover “operative procedures to treat a mental condition.”

Mississippi Gov. Tate Reeves said that the Biden administration “attempted to undermine Title IX by dramatically reinterpreting its meaning to now apply to gender identity.”

“I’m thankful to see that this judge has chosen to side with Mississippi and other states who chose to stand up for women and defend Title IX as it currently exists,” he added.

The U.S. Department of Health and Human Services, the U.S. Office for Civil Rights and the attorneys general for Tennessee and Mississippi did not immediately respond to requests for comment. The office of Tennessee Gov. Bill Lee said it wouldn’t comment on pending litigation.

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