Court Vacates Contraceptive Mandate Exemptions
On August 13, 2025, a trial court in Pennsylvania v. Trump ruled that the 2017 rules expanding exemptions from the Affordable Care Act’s (ACA) contraceptive mandate were arbitrary and capricious and did not follow required rule making procedures.
As a result, the expanded exemptions for employers with religious or moral objections can no longer be relied upon. The ruling is expected to be appealed to the Third Circuit.
Go Deeper:
The ACA requires non-grandfathered medical plans to cover preventive services and drugs without cost-sharing, including contraceptives and sterilization.
-
In 2017, rules allowed most employers with sincerely held religious or moral objections to be exempt from covering contraceptives.
-
In 2020, SCOTUS upheld those rules as valid under statutory authority and the Religious Freedom Restoration Act.
-
The Biden administration proposed undoing parts of the rules, but the proposals were withdrawn after President Trump’s election.
The trial court struck down the 2017 rules in their entirety, finding that:
-
The religious exemption was too broad, extending to nearly any employer without sufficient justification.
-
The moral exemption relied on improper factors not authorized by Congress.
-
The government failed to explain why broader exemptions were necessary compared to earlier narrow exemptions.
Employer Compliance Options Remaining:
-
Outright exemption (very limited):
-
Applies only to churches, associations of churches, integrated auxiliaries, and exclusively religious activities of religious orders (per 2013 rules).
-
-
Accommodation process (for some religious organizations and closely held for-profits):
-
Option 1: Self-certify to insurer/TPA (EBSA Form 700). Insurer/TPA provides contraceptive coverage directly to participants and notifies them annually.
-
Option 2: Self-certify to DOL or HHS. Agencies notify insurer/TPA, who then provides the coverage and annual notice.
-
-
Permanent injunctions apply to:
-
Employers in Assn. of Christian Schools International v. Azar
-
Members of the Christian Employers Alliance
-
-
All other employers:
-
Must comply with the ACA and cover all required contraceptive and sterilization services.
-
Potential Impact to Employers:
-
Employers relying on the 2017 expanded exemptions must now comply with existing ACA rules.
-
Religious nonprofits or closely held for-profits may use the accommodation process, but outright exemption is limited to narrow categories.
-
Litigation is expected to continue and could ultimately reach the Supreme Court again.
-
For most employers with non-grandfathered plans, contraceptive and sterilization coverage must be provided.