The Eleventh Circuit Court of Appeals has ruled that employers are liable under Title VII of the Civil Rights Act for denying insurance coverage for gender-affirming care. This decision was made in the case of Lange v. Houston County, where a transgender county sheriff's deputy sued a Georgia county for its health plan's ban on covering gender-confirmation surgery. The court found that the ban violated federal anti-discrimination law, specifically Title VII and the Bostock decision. The ruling was made by a divided panel, with Judges Wilson and Jill Pryor in the majority and Judge Brasher dissenting. This marks the first time Biden's updated Title VII guidance has been cited in a major transgender rights ruling. The court also noted that cost savings are not an excuse for employment discrimination.