Mara Silvers, Montana Free Press

The Tuesday ruling leaves transgender advocates and the state health departments in another legal standoff.

The state’s high court previously considered the case in 2019, after a district court temporarily allowed Helen Weems, a nurse practitioner and the owner of All Families Healthcare in Whitefish, to provide abortions while the case proceeded.

House Bill 702 had barred employers from mandating vaccines or requiring employees share their vaccine status. U.S. District Court Judge Donald Molloy ruled that it was unconstitutional and conflicted with federal law.

The Montana state health department has expanded its contract with a private consulting group hired to oversee the struggling Montana State Hospital and other public health care facilities. The amended agreement with Alvarez & Marsal went into effect Oct. 1.

The agency had previously said it would continue to bar document changes for transgender people despite a verbal court ruling.

The rule, which puts Montana among the strictest states in the nation, effectively bars transgender people from changing the sex on their birth certificates.

The ruling upholds a district court ruling from October in the case filed by Planned Parenthood of Montana.

The emergency rule skirts a recent order from a Billings district court judge.

This fall, Montana delivered as many as 113,000 antigen tests to hospitals, health clinics, government offices, local health departments and others. But communication on how to access tests has been inconsistent, such as with certain detention centers and child care providers.

The injunction comes a week after the same judge issued a temporary restraining order that stalled the laws for 10 days.