Transgender and Abortion Mandate
Section 1557 Injunction

Frequently Asked Questions

In August 2021, a federal court issued a decision affirming the religious freedom right of CMDA members to avoid participating in gender transitions and abortions. And in August 2022, a federal appeals court unanimously affirmed that previous decision. The following questions are intended to help CMDA members understand the valuable protection the order provides for them.

Q. I’m a CMDA member. How does the court’s order protect me?
A. The court’s order permits you to decline to perform or provide insurance coverage for gender transitions or abortions, without being penalized by the federal government under the antidiscrimination provisions of the Affordable Care Act (ACA).

Specifically, the order blocks the federal agency overseeing healthcare—the United States Department of Health and Human Services (HHS)—from penalizing you under Section 1557 of the ACA for not performing or insuring these procedures. You have a court-protected right to decline to perform or insure gender transitions and abortions, consistent with your religious beliefs and professional judgment, without HHS penalizing you under this law.

Q. What does the order mean by “gender-transition procedures?”
A. The order defines “gender-transition procedures” to include any treatment—like surgery, drugs or counseling—sought in furtherance of a gender transition.

Q. What is HHS blocked from doing to me?
A. HHS can’t use its power under Section 1557 to assess any penalties, pursue any investigations or withhold any financial assistance—like Medicare and Medicaid funding—from you based on your refusal to participate in these procedures.
If HHS attempts to take any of these actions, you can notify the responsible official that you’re a CMDA member and are protected by the court’s order. The order then requires HHS to pull back or else risk contempt of court.

Q. Can HHS penalize my employer if I don’t participate in these procedures?
A. No. The order blocks HHS from penalizing you or anyone acting “in concert or participation with” you, based on your refusal to perform or insure these procedures.

Q. Where do I go for more information?
A. If you have questions about how this order applies to your specific situation, you will likely need to consult an attorney licensed in your jurisdiction.

Q. What if I am not a current member of CMDA? If I join, will I be protected by this permanent injunction?
A. Yes. The permanent injunction protects all members of CMDA, current and future, so if you were to become a member of CMDA, the permanent injunction would also protect you.

Q. What is the name of the case and where can I find additional information?
A. The name of the case is Franciscan Alliance v. Becerra. Case detail is available on the Becket Religious Liberty website at