Catholic Social Services (CSS), a foster care agency, brought the lawsuit claiming a constitutional right to discriminate against same-sex potential foster parents in violation of the agency’s contract with the City of Philadelphia and the City’s anti-discrimination ordinance. The district court denied CSS’s motion for a preliminary injunction, and CSS appealed.

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.