Universal APA Vacatur Elsewhere Moots Parallel Challenges to an Agency Rule

1. Introduction

This appeal arose from Florida’s and related entities’ challenge—joined by the Catholic Medical Association—to HHS’s 2024 rule implementing § 1557 of the Affordable Care Act (ACA), Nondiscrimination in Health Programs & Activities, 89 Fed. Reg. 37522 (May 6, 2024) (the “2024 Rule”). The plaintiffs argued that HHS exceeded statutory authority (primarily under the ACA and also in CMS-related amendments under the Social Security Act) by defining sex discrimination to include gender identity and by constraining denials/limits of gender-affirming care and coverage. They also pressed Spending Clause “clear statement” objections, and the Catholic Medical Association asserted First Amendment and RFRA/free-exercise claims.

The district court initially issued a preliminary injunction staying/enjoining several provisions in Florida, but after a change in presidential administration the district court dismissed the case as moot. On appeal, the Eleventh Circuit did not decide whether mootness existed at the moment of dismissal. Instead, it held the case became moot during the appeal because a separate case—Tennessee v. Kennedy—vacated the same challenged provisions via APA vacatur, the government did not appeal, and HHS formally recognized those provisions as “legally void.”

Key parties and posture

• Plaintiffs-Appellants: State of Florida; Florida Agency for Health Care Administration; Florida Department of Management Services; Catholic Medical Association.
• Defendants-Appellees: HHS, CMS, and federal officials (collectively “the Secretary”).
• Procedural pivot: While this appeal was pending, Tennessee v. Kennedy entered summary judgment and issued “universal vacatur” of the gender-identity-related provisions; HHS did not appeal and later issued a Notice of Vacatur stating those provisions are void and unenforceable.

2. Summary of the Opinion

The court treated APA vacatur as a remedy that makes the vacated portions “of no effect,” retroactively expunging the agency action. Because the Tennessee court vacated (and HHS accepted as void) the same provisions Florida challenged, any injunction or declaration in this case would be purely advisory. The court rejected Florida’s effort to invoke the “voluntary cessation” mootness standard, reasoning that mootness flowed from a court-ordered vacatur, not a discretionary policy change by the agency. The court also held that Florida could not salvage a live controversy by pointing to “sex stereotypes” language in the Rule, because that was not challenged in the complaint and was raised for the first time on appeal.

3. Analysis

3.1 Precedents Cited

Mootness framework and Article III limits

• Al Najjar v. Ashcroft, 273 F.3d 1330 (11th Cir. 2001): The court drew its central test from Al Najjar: if post-filing events deprive a court of the ability to grant “meaningful relief,” the case is moot and must be dismissed. It also relied on Al Najjar for the “usual” practice of vacating and remanding when mootness arises on appeal—then explained why it did not do so here.
• Already, LLC v. Nike, Inc., 568 U.S. 85 (2013): Quoted for the principle that a case is moot when a dispute is no longer embedded in an actual controversy about the plaintiff’s particular legal rights, even if parties still contest legality in the abstract. The court also used Already to identify the “voluntary cessation” standard that Florida invoked, and to explain why it did not apply.
• Warren v. DeSantis, 125 F.4th 1361 (11th Cir. 2025): Cited for the prohibition on advisory opinions and the requirement that moot merits decisions are impermissible under Article III.

Vacatur under the APA as the “ordinary” remedy and its legal effect

• Ins. Mktg. Coal. Ltd. v. FCC, 127 F.4th 303 (11th Cir. 2025): Cited for the proposition that “vacatur is the ordinary APA remedy,” grounding the court’s remedial analysis in Eleventh Circuit administrative-law doctrine.
• Alabama v. Ctrs. for Medicare & Medicaid Servs., 674 F.3d 1241 (11th Cir. 2012): Used for the key characterization: when a rule is vacated, it is “of no effect.” This supported the conclusion that plaintiffs cannot be injured by (or obtain prospective relief against) provisions that are void.
• Driftless Area Land Conservancy v. Valcq, 16 F.4th 508 (7th Cir. 2021): Cited to explain that vacatur “retroactively undoes or expunges” an agency action—reinforcing the retroactive nullification effect.
• Data Mktg. P'ship, LP v. U.S. Dep't of Lab., 45 F.4th 846 (5th Cir. 2022): Cited for the formulation that vacatur “formally nullif[ies] and revoke[s]” the agency action, aligning multiple circuits’ descriptions of vacatur’s operative consequence.
• Jonathan F. Mitchell, The Writ-of-Erasure Fallacy, 104 Va. L. Rev. 933 (2018): Used as scholarly support for the practical meaning of vacatur under the APA—bolstering the court’s conclusion that vacated rules are legally void.

Mootness of challenges when the challenged law/rule is removed or expires

• Covenant Christian Ministries, Inc. v. City of Marietta, 654 F.3d 1231 (11th Cir. 2011): The court analogized: when “challenged features” are removed, challenges become moot. Here, the “removal” occurred through vacatur rather than legislative repeal.
• Aaron Priv. Clinic Mgmt. LLC v. Berry, 912 F.3d 1330 (11th Cir. 2019): Cited to show injunctive claims become moot when the challenged enforcement risk disappears (there, expiration of a moratorium; here, vacatur voiding the provisions).
• Burke v. Barnes, 479 U.S. 361 (1987): Cited for the proposition that declaratory-judgment claims become moot when the challenged law expires (again, by analogy to vacatur).
• Wyoming v. U.S. Dep't of Interior, 587 F.3d 1245 (10th Cir. 2009): Quoted (Gorsuch, J.) for the warning against adjudicating issues that would have “no effect in the world we now inhabit,” underscoring the advisory-opinion problem once a rule is void.

Standards for injunctive/declaratory relief and “recurrence”

• Adler v. Duval Cnty. Sch. Bd., 112 F.3d 1475 (11th Cir. 1997): Cited for the principle that injunctions are prospective and designed to prevent future injuries.
• Cambridge Christian Sch., Inc. v. Fla. High Sch. Athletic Ass'n, Inc., 115 F.4th 1266 (11th Cir. 2024): Provided the “cognizable danger of recurrent violation” requirement for injunctive relief and the “substantial controversy…of sufficient immediacy and reality” test for declaratory relief. The court used these standards to conclude vacatur eliminates any cognizable danger and immediacy.
• Monsanto Co. v. Geertson Seed Farms, 561 U.S. 139 (2010): Cited for the idea that when vacatur redresses the injury, an injunction is generally unnecessary—supporting why Florida’s request for an injunction no longer mattered.

Universal injunctions vs. universal vacatur; scope questions noted but not resolved

• Trump v. CASA, Inc., 606 U.S. 831 (2025): The panel acknowledged the Supreme Court’s skepticism about “universal injunctions,” but emphasized CASA treated universal vacatur under the APA as a “distinct question.” This allowed the panel to treat Tennessee’s vacatur as operative without deciding the broader remedial debate.
• Corner Post, Inc. v. Bd. of Governors. of the Fed. Rsrv. Sys., 603 U.S. 799 (2024) (Kavanaugh, J., concurring): Cited to reject the argument that universal vacatur is “novel and wrong,” further insulating the mootness conclusion from Florida’s remedial critique.

Raising new issues on appeal

• Access Now, Inc. v. Sw. Airlines Co., 385 F.3d 1324 (11th Cir. 2004): Used to reject Florida’s attempt to pivot on appeal to an unpled challenge (sex-stereotypes language), reinforcing that mootness cannot be avoided by new theories first asserted on appeal.

Related litigation referenced for context

• Texas v. Becerra, No. 6:24-cv-211, 2024 WL 4490621 (E.D. Tex. Aug. 30, 2024): Mentioned to explain that, even when Florida’s injunction was lifted procedurally, the challenged provisions still did not take effect because a nationwide stay existed.
• Tennessee v. Kennedy, 807 F. Supp. 3d 613 (S.D. Miss. 2025): The decisive intervening judgment: summary judgment finding HHS exceeded authority by including gender identity in “sex discrimination,” followed by universal vacatur of specific provisions and declaratory relief; not appealed by the Secretary.

3.2 Legal Reasoning

(a) The court’s central move: vacatur-as-nullification eliminates meaningful relief

The panel treated APA vacatur under 5 U.S.C. § 706(2) as an operative legal event that removes the challenged rule provisions from the legal universe. Relying on Eleventh Circuit and cross-circuit descriptions, the court reasoned that vacatur does not merely restrain enforcement against particular plaintiffs; it “set[s] aside” the agency action such that it is “of no effect” and “formally nullif[ied].” From that premise, mootness followed in a straightforward sequence:

• The plaintiffs challenged specific provisions tying § 1557 sex discrimination to gender identity and limiting denials/limits of gender-affirming care/coverage, plus related notice/policy provisions and CMS contract/cultural-competency amendments.
• Tennessee v. Kennedy vacated those same provisions “to the extent” they expanded sex discrimination to include gender identity, and the judgment became final (no appeal).
• HHS then publicly confirmed via Notice of Vacatur that the vacated provisions are “legally void” and will not be enforced.
• Therefore, a favorable ruling in Florida’s appeal could not change the plaintiffs’ legal position; it would be advisory.

(b) Why the “voluntary cessation” standard did not apply

Florida urged a heightened mootness standard—whether it is “absolutely clear” the wrongful behavior could not recur—drawn from voluntary cessation doctrine. The panel declined to apply it because the “cessation” was not a discretionary agency retreat; it was compelled by a court judgment that vacated the challenged provisions. In short, the mootness trigger was judicial nullification, not agency choice.

(c) Why ancillary remedies (injunction/declaration) could not keep the case alive

The panel separately addressed each form of relief Florida claimed still mattered:

• Injunction: Injunctions prevent future injury. With the provisions void, there was no “cognizable danger of recurrent violation” under Cambridge Christian Sch., Inc. v. Fla. High Sch. Athletic Ass'n, Inc..
• Declaratory relief: A declaration requires an immediate, real controversy. Once the challenged provisions were vacated, any dispute about them lacked immediacy.
• Non-APA claims (Spending Clause, First Amendment, RFRA): Even if the Tennessee court did not adjudicate those theories, the object of those theories—the now-void rule provisions—was gone, so resolving the theories would not affect present legal rights.

(d) Pleading discipline: plaintiffs could not pivot to “sex stereotypes”

Florida attempted to avoid mootness by arguing that 45 C.F.R. § 92.101(a)(2)(v) (sex stereotypes) remained in force after Tennessee. But because the complaint did not actually challenge that component, the panel treated the argument as an improper new issue under Access Now, Inc. v. Sw. Airlines Co.. This mattered doctrinally: mootness was assessed against the claims and provisions actually litigated, not against a newly identified residual regulatory phrase.

3.3 Impact

1) Practical effect: parallel challenges can be mooted by final vacatur elsewhere

The decision underscores a litigation reality in nationwide administrative-law disputes: once a rule (or key provisions) is vacated in another case in a manner understood to have general legal effect, parallel challenges—especially those seeking to “set aside” the same provisions—may become moot even if filed first or accompanied by constitutional claims.

2) Clarification (within Eleventh Circuit reasoning): vacatur is not merely party-specific relief

Without squarely adjudicating the contested theory of “universal vacatur,” the panel nevertheless treated Tennessee’s vacatur as legally dispositive for nonparties. The opinion thus operationalizes (at least for mootness analysis) the view that vacatur “nullifies” agency action, which can eliminate injury for parties in other jurisdictions.

3) Remedy strategy and appellate incentives

The case highlights the strategic importance of appeals from vacatur judgments: because the Secretary did not appeal Tennessee v. Kennedy, that judgment became the intervening event that ended Florida’s appeal. Future challengers and agencies may treat appellate decisions (or non-decisions) in one forum as capable of effectively ending litigation in others.

4) Relationship to the universal-injunction debate

By citing Trump v. CASA, Inc. and Corner Post, Inc. v. Bd. of Governors. of the Fed. Rsrv. Sys. (Kavanaugh, J., concurring), the panel positioned vacatur as doctrinally distinct from universal injunctions. The court did not resolve the legality of universal vacatur, but its mootness holding assumes vacatur can have broad legal consequences—an assumption likely to be tested in future Supreme Court litigation.

4. Complex Concepts Simplified

• Mootness: A case is “moot” when a court’s decision can no longer change the parties’ real-world legal rights—so any ruling would be an advisory opinion, which Article III forbids.
• APA vacatur (“set aside”): When a court vacates an agency rule under the APA, it treats the vacated rule (or portions) as legally void—like striking it from the books—rather than merely telling the agency not to enforce it against the named plaintiffs.
• Universal injunction vs. universal vacatur: A universal injunction bars enforcement against everyone; universal vacatur treats the rule itself as invalid/void. The Supreme Court has expressed skepticism about the former; the status of the latter is debated and was not decided here.
• Voluntary cessation: A special mootness rule used when a defendant stops challenged conduct by choice (courts worry the defendant might resume). The Eleventh Circuit said it did not apply because vacatur was imposed by a court judgment, not a voluntary agency pause.
• Spending Clause “clear statement”: When Congress attaches conditions to federal funds for states, it must do so unambiguously; Florida argued “sex” in 2010 did not clearly include gender identity. The court did not reach the merits because the challenged provisions were already void.

5. Conclusion

State of Florida v. Department of Health and Human Services establishes (in practical, precedential form within this unpublished disposition) a clear operational rule for mootness in regulatory litigation: when an intervening, final APA vacatur in another case nullifies the same challenged rule provisions, a parallel appeal seeking to vacate, enjoin, or declare those provisions unlawful becomes moot because no meaningful relief remains to award. The opinion also signals that voluntary-cessation doctrine is inapt where the cessation is compelled by judicial vacatur, and it reinforces appellate pleading discipline by rejecting attempts to salvage a case with newly raised regulatory targets.