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Transgender Iowans sue over state’s latest attempt to restrict Medicaid funding

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Aiden Vasquez (left) and his wife, Tammi Vasquez. — courtesy of the ACLU of Iowa

On Friday, the ACLU of Iowa filed a lawsuit in state district court on behalf of two transgender Iowans and the LGBTQ rights group One Iowa, that seeks to overturn the state’s ban on the use of Medicaid funds to pay for sex reassignment procedures deemed medically necessary by doctors.

The ban was in a last-minute amendment to the Iowa Department of Human Services (DHS) budget bill that Iowa Senate Republicans introduced on the final day of this year’s legislative session. The amendment was intended to negate a unanimous ruling by the Iowa Supreme Court in March, which struck down an almost identical ban because it violated the Iowa Civil Rights Act’s prohibition of discrimination based on actual or perceived sexual orientation or gender identity.

“This cruel amendment has no basis in medicine or science,” ACLU of Iowa Legal Director Rita Bettis Austen said in a press release announcing the filing of the lawsuit. “Every major medical association agrees gender dysphoria is a serious medical condition and that surgical treatment is medically necessary for some transgender people. That includes the American Medical Association, the American Psychological Association, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the National Association of Social Workers, and the World Professional Association of Transgender Health.”

During the very limited debate that Republican leaders in the Senate allowed, Sen. Jake Chapman, R-Adel, said he considered sex reassignment and gender confirmation procedures to be “an elective decision. If Iowans want to do that, that’s fine, but not with our taxpayer dollars.”

“I am participating in this lawsuit to get the medical care I desperately need, and to pave the way for other transgender Iowans who need it too,” Aiden Vasquez, one of the lawsuit’s plaintiffs, said in a written statement. “I’ve spent my whole life living in a body that wasn’t mine, feeling fake and hopeless.”

Like his fellow plaintiff, Mika Covington, Vasquez qualifies for Medicaid and planned to have the gender confirmation surgery his doctor prescribed in September.

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

In its March ruling, the Iowa Supreme Court affirmed a district court decision rejecting DHS’s argument that gender confirmation surgery was a type of elective cosmetic surgery, undertaken for “primarily for psychological purpose.”

“DHS failed [in its obligation to keep up with medical science] when it denied coverage… for medically necessary gender affirming surgery,” Polk County District Court Judge Arthur Gamble wrote in his ruling. “This decision was made without regard to the law and facts. The agency acted in the face of evidence upon which there is no room for difference of opinion among reasonable minds.”

Bettis Austen called the new amendment to cutoff Medicaid funds “a clear violation of equal protection under the Iowa Constitution because it facially and intentionally discriminates against people simply because they are transgender.”

In 2007, the Iowa legislature amended the state’s civil rights act to prohibit discrimination based on actual or perceived sexual orientation or gender identity, but transgender citizens have been facing increasing attempts to undermine their rights in recent years at both the state and federal levels.

“Tragically, society shames transgender people just for being who they are,” Vasquez said. “But I’m not hiding anymore. I’m determined to help myself, and in that way, help others.”

The ACLU of Iowa represented the transgender Iowans who successfully sued to overturn the previous ban on the use of Medicaid funds for gender-affirming medical procedures. That was the second legal victory the group helped secure for the state’s transgender community this year.

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In February, a Polk County jury ruled in favor of the plaintiff in the first discrimination lawsuit filed in Iowa by a transgender plaintiff since the Iowa Civil Rights Act was amended to include protection for gender identity. In addition to finding the state illegally discriminated against Jesse Vroegh, a transgender man and former Iowa Department of Corrections employee, the jury awarded him $120,000 in damages.

This is the third lawsuit the ACLU has brought over a law passed by the Iowa legislature in its last session. On Wednesday, a district court judge issued a temporary injunction preventing enforcement of a new law prohibiting Planned Parenthood from receiving government grants to provide sex education programs. In April, it sued the state over a new “ag gag” law, on behalf of several nonprofits, dedicated to animal welfare and food safety. The legislature passed that law two months after a federal judge struck down the state’s previous ag gag law.


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