On September 10, 2025, the U.S. Court of Appeals for the Fifth Circuit dismissed an appeal of the federal court ruling vacating key provisions of the HIPAA reproductive health care regulations, which appears to signal the end of the Purl case (previously discussed here) and to confirm the end of provisions of the HIPAA reproductive health care regulations which had afforded heightened protection to protected health information (PHI) related to the receipt of lawful reproductive health care services.
In a June 2025 ruling in Purl v. Department of Health & Human Services, the district court for the Northern District of Texas vacated provisions of the Biden-era Reproductive Health Privacy Rule (the Rule) which established new HIPAA regulations with heightened privacy protections and processes related to uses and disclosures of PHI involving reproductive health care. The federal government subsequently declined to appeal that ruling, but a group of proposed intervenors (specifically, the cities of Columbus, Ohio, and Madison, Wisconsin, as well as Doctors for America), filed a notice of appeal to potentially step in to defend the Rule’s requirements. However, the proposed intervenors subsequently reversed course and voluntarily moved to dismiss their appeal, and the Fifth Circuit granted that motion, leaving in place the district court’s vacating of the Rule’s reproductive health care regulations.
Background
In 2024, under the Biden administration, HHS promulgated the “HIPAA Privacy Rule To Support Reproductive Health Care Privacy,” which sought to better protect reproductive health records under HIPAA following the 2022 ruling in Dobbs v. Jackson Women’s Health Organization. The Rule’s stated intent was in part to protect and preserve reproductive care performed lawfully, as well as to protect the provider-patient trust that facilitates that care. The Rule therefore set forth specific protections for PHI related to the lawful receipt of reproductive health care and implemented a new attestation requirement for certain uses and disclosures of PHI involving reproductive health care.
In late 2024, a physician and sole owner of a family medicine clinic challenged the Rule in federal court in Texas, alleging that the requirements under the Rule were inconsistent with state child abuse and neglect reporting laws, therefore preventing providers from complying with both at the same time. As the suit progressed (with the district court having granted a preliminary injunction against enforcement of the Rule), the proposed intervenors—sensing a potential loss and foreseeing little likelihood that the new administration would defend the Rule—moved to intervene in the case to defend their interests in the Rule’s continued existence.
In June 2025, the district court vacated key provisions of the Rule related to reproductive health care (while permitting other provisions related to Notices of Privacy Practices to remain in effect), finding that HHS exceeded its authority in promulgating the Rule. Around the same time, the district court denied the motion to intervene, which the proposed intervenors swiftly appealed to the Fifth Circuit. As discussed below, however, that appeal has been dismissed.
Appeal of Vacatur and Subsequent Motion to Dismiss
After the June decision vacating the Rule’s reproductive health care provisions, HHS declined to file an appeal by the August 18, 2025, deadline. As that deadline neared, the proposed intervenors filed an appeal on August 15, 2025, seeking to reverse the District Court’s grant of summary judgment to the plaintiffs and seeking the denial of defendants’ motion to dismiss in the Fifth Circuit, pending resolution of their appeal regarding the motion to intervene. In a September 2, 2025, letter to the Fifth Circuit, the government confirmed, that it has no plans to appeal the ruling.
The proposed intervenors subsequently moved to dismiss their pending appeals in the Fifth Circuit on September 4, 2025. The motion indicated that “[HHS has] chosen not to appeal the District Court’s Summary Judgment Orders, and [the proposed intervenors] have concluded that the resources of the parties and the courts would be best conserved by dismissing this appeal.” The Fifth Circuit granted the motion and dismissed the case on September 10, 2025.
Implications
The dismissal of the appeal, and the government’s election to not further challenge the district court’s ruling in Purl, appear to end the reproductive health care protections under HIPAA that had been promulgated under the Rule. HHS has indicated that it continues to review the ruling and implications for its HIPAA rulemaking, but it appears likely that HHS will issue updated guidance and/or revoke the HIPAA reproductive health care regulations. We will continue to monitor HIPAA rulemaking and legislative developments related to the delivery of reproductive health care, privacy, and security.