U.S. District Judge Haywood Gilliam in Oakland issued a preliminary injunction against the final rules for the new Affordable Care Act exemption on Sunday, though he limited it to the 13 states that sued, plus the District of Columbia.

The decision, which may be appealed, ramps up the culture war triggered by President Donald Trump’s attempt to extend “religious freedom” rights from churches to companies—a move that in 2017 triggered litigation backed by rights groups and Democratic-led states.

“The law couldn’t be clearer—employers have no business interfering in women’s health care decisions,” California Attorney General Xavier Becerra, who led the state coalition, said in a statement. “Today’s court ruling stops another attempt by the Trump Administration to trample on women’s access to basic reproductive care.”

‘Dire’ Consequences

The other states impacted by the ruling are Connecticut, Delaware, Hawaii, Illinois, Maryland, Minnesota, New York, North Carolina, Rhode Island, Vermont, Virginia, and Washington.

“No American should be forced to violate his or her own conscience in order to abide by the laws and regulations governing our healthcare system,” Caitlin Oakley, a spokeswoman for the U.S. Department of Health & Human Services, said in an email.

Gilliam said the states hadn’t met the high threshold required for granting a nationwide injunction, despite showing they face “potentially dire public health and fiscal consequences from the implementation of the final rules.” Still, he added that “the court fully recognizes that limiting the scope of this injunction to the Plaintiff States means that women in other states are at risk of losing access to cost-free contraceptives when the final rules take effect.”

There is still a chance that a nationwide injunction could be issued in a separate case by Pennsylvania Attorney General Josh Shapiro and his New Jersey counterpart, Gurbir Grewal. Leana Wen, a doctor and president of Planned Parenthood Federation of America, said the organization is waiting for that ruling to see if women in the rest of the country will have the same access to birth control under the ACA.

“Affordable, accessible birth control is why the U.S. has reached the lowest unintended pregnancy rate in 30 years,” Wen said in a statement. “It’s time that politicians recognize birth control as health care and that women, in consultation with doctors, decide what contraception we receive — not our employers.”

‘Moral Exemption’

Gilliam said the religious exemption has the effect of “depriving female employees, students and other beneficiaries” of their right to “seamlessly-provided contraceptive coverage at no cost.”

He set a hearing for Jan. 23.

An interim version of the new rules was previously blocked nationwide by Gilliam and by a Philadelphia judge, though a San Francisco-based appeals court later said Gilliam should have limited the scope of his injunction to the states in California’s coalition. A lawsuit by the Massachusetts attorney general was rejected on the grounds that the state didn’t have standing to sue. That ruling is on appeal.

Haywood’s ruling, for now, blocks the religious and moral exemptions to the Obamacare requirement from taking effect in the California-led group of states while the litigation plays out, potentially heading to trial. The U.S. Supreme Court will probably have the final say on the matter.

Religious organizations are already exempted, but Trump seeks to roll back the free contraception requirement for more categories of employers, including publicly traded companies.

“It is a good day when a court stops this administration from sanctioning discrimination under the guise of religion or morality,” the American Civil Liberties Union said in a statement.