The Supreme Court on Monday wiped away a series of lower court decisions that favored transgender litigants, sending the cases back to the appellate level for reconsideration in light of the court’s recent ruling upholding a Tennessee ban on puberty blockers and hormone therapy for minors.

The 6-3 decision in United States v. Skrmetti, handed down June 18, marked a major victory for state-level efforts to restrict transgender procedures for minors. The ruling has now prompted the justices to vacate multiple decisions from lower courts in cases involving health benefits and birth certificate policies for people who identify as transgender.

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In an order list issued Monday morning, the high court overturned appellate rulings that previously blocked state-level bans or coverage restrictions for transgender-related care in North Carolina, West Virginia, Idaho, and Oklahoma. The move means each case must now be reheard under the legal standard articulated in the Skrmetti ruling, which found no violation of the Constitution’s equal protection clause in a ban on medical treatments for minors who identify as transgender.

The high court also declined to take up a separate appeal from Kentucky, where families challenged the state’s similar law banning transgender procedures for minors.

In Skrmetti, the Supreme Court held that Tennessee’s law did not discriminate based on sex or transgender status, giving states wide latitude to regulate medical procedures offered to minors. The ruling did not address transgender status more broadly, and it did not interfere with the precedent set in the 2020 Bostock v. Clayton County decision, which said employers cannot discriminate against people based on gender identity.

But as a result of the most recent transgender-related high court case, the 4th U.S. Circuit Court of Appeals must now reconsider its prior ruling that North Carolina and West Virginia violated the Constitution by refusing to cover certain treatments for transgender people through state insurance programs. Meanwhile, the 9th Circuit will reexamine a similar challenge in Idaho, and the 10th Circuit will revisit its decision blocking Oklahoma from banning gender changes on birth certificates.

Monday’s actions come as the justices continue to weigh whether to take up additional cases, including challenges to school sports participation rules in Arizona, Idaho, and West Virginia that restrict biological boys from competing on girls sports teams.

HOW THE SUPREME COURT SKRMETTI RULING RESHAPES US LEGAL CASES

A decision on whether to grant review in those cases could come as soon as Thursday, when the high court is set to release another orders list.

While Monday’s order was expected in light of the latest precedent shift, it underscores how Skrmetti is reshaping the legal landscape on transgender issues and raising the stakes for appeals involving schools, healthcare, and identity documentation.