The Supreme Court on Monday wiped away a series of lower court decisions that favored transgender litigants, sending the cases back to the appellate level for reconsideration in light of the court’s recent ruling upholding a Tennessee ban on puberty blockers and hormone therapy for minors.

The ruling left unsettled the question of whether children born to immigrants without full legal status in the United States are entitled to automatic citizenship. So what happens now?

The justices ordered the 4th U.S. Circuit Court of Appeals in Richmond, Virginia, to review its decision that West Virginia’s and North Carolina’s refusal to cover certain health care for transgender people with government-sponsored insurance is discriminatory.