The U.S. Supreme Court ruled in Fulton v. City of Philadelphia that the City of Philadelphia violated the Free Exercise Clause of the First Amendment by failing to give Catholic Social Services (CSS) an exemption from the nondiscrimination provision in city contracts, even though the contract authorized exemptions and the City had granted exemptions to other providers.

Mariah L. sought coverage for transition-related healthcare as a 20-year-old transgender woman in foster care in New York City. Mariah’s doctors have all agreed that sex reassignment surgery is medically necessary for her. In New York, the Administration for Children’s Services (ACS) has a duty to provide and pay for all necessary medical care and treatment for children placed in foster care, but ACS has refused to provide Mariah with the medical care that she needs.