(The Center Square) – Texas and Montana have sued the Biden administration over another federal rule change it implemented, this time over one that requires states to pay for “gender transition” procedures through their Medicaid programs.

It also requires health-care providers to perform such procedures in states where the practice has been banned, including in Montana and Texas. Their state legislatures passed bills their governors signed into law prohibiting “gender transition” procedures from being performed on minors in their states, among other restrictions.

The lawsuit was filed in the U.S. District Court Eastern District of Texas Tyler Division. It names U.S. Secretary of Health and Human Services Secretary Xavier Becerra and Melanie Fontes Rainer, the director of the Office of Civil Rights within the Centers for Medicare and Medicaid Services, as well as CMMS and HHS, as defendants.

At issue are changes to the HHS’ CMMS rule, “Nondiscrimination in Health Programs and Activities,” promulgated last month under Section 1557 of the Patient Protection and Affordable Care Act (ACA). It requires health-care providers to perform “gender-transition” medical procedures, including on children, or risk losing federal funding.

It also includes multiple definitions and amendments to regulations related to sexual orientation and gender identity. It is slated to become effective 60 days from May 6, when it was published in the Federal Register.

The lawsuit argues, “Section 1557 does not authorize – and has never authorized – the federal government to compel anyone to perform or pay for ‘gender-transition’ procedures.” It also argues the rule change is unlawful, violates the Constitution, and asks the court to “set it aside and issue injunctive relief.”

“The Biden Administration is attempting to exact radical social change by defunding States and healthcare providers across the country who refuse to provide or pay for dangerous and experimental ‘gender-transition’ medical activities,” the complaint states. “Through a sweeping new rule promulgated under the Affordable Care Act (ACA), those who do not conform to the Biden Administration’s gender-ideology regime stand to lose all federal healthcare funds, including Medicaid and Medicare dollars.”

The rule “purports to override and preempt all State laws to the contrary, ensuring that the Biden Administration’s assumption of control over the States’ regulation of health and safety is complete,” the complaint continues. It also notes that the rule “relies on a misapplication of the Affordable Care Act which never authorized HHS or any government agency to compel institutions to perform or pay for these procedures.”

“This is yet another example of Joe Biden trying to sidestep the Constitution and use agency rulemaking to advance unpopular, unlawful, and destructive policies,” Texas Attorney General Paxton said. “We are suing to stop the Biden Administration from withholding federal healthcare funds to force medical professionals to perform these experimental and dangerous procedures.”

Montana Attorney General Austin Knudsen made similar arguments, adding that “Healthcare providers should not be forced to perform dangerous and life-altering experimental procedures under the threat of losing the federal funding they rely on to keep their doors open. And the states should not be compelled to foot the bill for treatments that are leaving people, even children, with irreversible damage.”

Knudsen, who has led the charge to protect female athletes and students protected under Title IX, also notes that Section 1157 originally banned any federally funded health program from discriminating on grounds prohibited under Title IX.

Title IX, which is part of the Education Amendments Act of 1972, prohibits discrimination “on the basis of sex.” It states, “No person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any education program or activity receiving Federal financial assistance.”

Over two years ago, Knudsen led a coalition of 15 AGs calling on the U.S. Department of Education to cancel its plan to revise Title IX, The Center Square reported. The administration ignored their request and published its controversial rule change roughly two years later. Montana, Texas and multiple states sued, arguing the rule change was illegal.

Both the DOE and HHS CMMS rule changes equate “sex” discrimination with discrimination based on “gender identity,” a wrong interpretation of federal law, the lawsuits argue.

The HHS CMMS rule “will wreak financial havoc” on states’ medical systems, the AGs argue. States receive billions of dollars in federal health-care aid to administer several welfare programs. The rule imposes “unlawful strings on that aid,” penalizing states that prohibit “gender transition” procedures and health plans from insuring them.