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Judge strikes down Iowa’s ban on Medicaid covering gender-affirming medical procedures


Blair Gauntt/Little Village

In 2019, the Iowa Supreme Court struck down a state regulation prohibiting Medicaid from covering gender-affirming procedures deemed medically necessary, finding it violated the Iowa Civil Rights Act (ICRA). Republicans in the state legislature responded by passing a statute intended to amend the ICRA and make that sort of discrimination legal by prohibiting “any state or local government or tax-payer supported district” from paying for gender-affirming procedures for transgender Iowans.

In other words, cutting off transgender Iowans from Medicaid funds in the exact way the Iowa Supreme Court found illegal.

On Monday, a Polk County District Court judge struck down that statute, ruling it “violate[s] the Iowa Civil Rights Act and the Equal Protection Clause of the Iowa Constitution.”

“This is a historic win for civil rights in Iowa,” Rita Bettis Austen, legal director of the ACLU of Iowa, said in a statement after the decision was announced. “It recognizes what we’ve long known, that transgender Iowans must not be discriminated against, and that they are protected by the Iowa Constitution’s guarantee of equal protection, as well as by the Iowa Civil Rights Act.”

The ACLU of Iowa and the national ACLU LGBTQ & HIV Project sued on behalf of two transgender Iowans, Aiden Vasquez and Mika Covington, after the Iowa Department of Human Services refused to allow Medicaid to cover gender-affirming medical procedures their doctors deemed necessary.

Aiden Vasquez — courtesy of the ACLU of Iowa.

“I am so glad to be able to take the next step forward. I desperately need this surgery. For me, it’s nothing short of life-saving,” Vasquez said. “The fact that I have had to jump through hoops just to try to get coverage for a surgery that could save my life has been mentally, emotionally, and physically draining. It is very hard for me to know that the state has gone out of its way to discriminate against me just because I’m transgender.”

Covington called Monday “an emotional day.”

“I have been suffering in this body and with gender dysphoria for so long,” she said. “As with so many other transgender people, because of the lack of medical care, this has been so heavy on me mentally and physically.”

“This care will be life-saving for me because I’m constantly bombarded every day with giving up, with suicidal thoughts, and thoughts of self-harm. The way transgender people are treated in our society and the way they are denied care is deeply painful. I am so glad we have gotten this recognition of the fundamental right of transgender people for medically necessary care.”

The statute the court struck down on Monday was introduced as a last-minute addition to the Iowa Department of Human Services budget bill by Republican leaders in the Iowa Senate in April 2019. Gov. Reynolds could have removed it using her line-item veto authority, but signed it into law instead. The governor has consistently defended the state’s attempt to ban transgender Iowans from accessing Medicaid funds to pay for gender-affirming procedures.

“The governor’s office is disappointed in today’s decision and disagrees with the district court’s ruling on Medicaid coverage for transgender reassignment surgeries,” Reynolds’ spokesperson said in a written statement on Monday.

Mika Covington with her dog, Teddy. — courtesy of the ACLU of Iowa

In his 60-page ruling, Judge William Kelly found the state had presented “no facts” to demonstrate it had a legitimate interest for its ban on the use of Medicaid funds.

Likewise, the Reynolds administration’s attorneys presented no evidence to show the use of Medicaid funds would be a financial burden on the state, while the plaintiffs submitted information demonstrating that “providing insurance coverage for transgender patients has been shown to be ‘affordable and cost-effective, and has a low budget impact,’” according to Kelly.

The plaintiffs also provided the court with medical literature “revealing there is a greater medical cost associated with denying transgender people access to medically necessary transition-related care and procedures.” Because providing that care leads to “significant reductions in suicide attempts, depression, anxiety, substance abuse” and other related problems.

The administration’s attorneys left that evidence “unrebutted.”

Judge Kelly concluded the state “should be prohibited from denying Medicaid coverage for medically necessary gender-affirming surgery for treating gender dysphoria.”

“This is so important because it affects the lives of so many transgender people in Iowa,” Mika Covington said following the decision. “Days like today make me proud to be an Iowan.”

According to the governor’s spokesperson, Reynolds is “reviewing the decision with our legal team and exploring all options moving forward.”


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