Iowa judge says yes to gender-affirming surgery coverage

Polk County District Court Judge William P. Kelly has ruled — Iowa must provide Medicaid coverage for gender-affirmation surgeries! 

A court struck today struck down as unconstitutional the State of Iowa’s practice of singling out transgender Iowans in Medicaid by denying them coverage of medically necessary, gender-affirming surgery.

Rita Bettis Austen, ACLU of Iowa Legal Director, said, “This is a historic win for civil rights in Iowa. 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 win follows a five-year struggle to secure equal Iowa Medicaid coverage of healthcare for transgender Iowans. The ACLU previously filed litigation in 2017 to block an Iowa Medicaid regulation that prevented the coverage. Courts affirmed that the care must be provided in 2019. 

But only two months later, the Iowa Legislature responded by passing a new law that specifically carved out discrimination against transgender Iowans in Medicaid coverage access from the Iowa Civil Rights Act protections in order to reinstate the earlier Medicaid regulation. A lawsuit was brought onto the state of Iowa Legislature by the ACLU of Iowa and the national ACLU LGBTQ & HIV Project on behalf of Iowans Aiden Vasquez (vass-kez) and Mika Covington. 

In a resolution to the lawsuit, the district court found that: 1) the Iowa law singling out and blocking medically necessary care for transgender Iowans in Medicaid was discriminatory and unconstitutional and 2) the Iowa Medicaid rule that also singled out and blocked medically necessary transgender care was discriminatory, unconstitutional, and a violation of the Iowa Civil Rights Act.

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“I am so glad to be able to take the next step forward, ” said Aiden Vasquez, a trans man living in southwestern Iowa. “I desperately need this surgery. For me, it’s nothing short of life-saving. The fact that I have had to jump through hoops and 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.”

He goes on to say: “I would like everyone to understand that this is not cosmetic surgery. It is not a whim. This has affected my whole life in a negative way and has affected my well-being. Not all transgender people need surgery, but I do. I am a man, but I was born into a body that I experience as not being who I am without this surgery.”

“This is an emotional day for me,” said Mika Covigton, a trans woman in central Iowa. “I have been suffering in this body and with gender dysphoria for so long. As with so many other transgender people, because of the lack of medical care, this has been so heavy on me mentally and physically.” 

She goes on to say: “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. It’s a huge step forward.”

There is consensus among every mainstream medical association, including the American Medical Association, that gender-affirming surgery is necessary, effective, life-saving care for some people suffering from gender dysphoria. Attorneys Seth A. Horvath, Tina B. Solis, and F. Thomas Hecht, Litigation Partners at the Chicago office of the national firm Nixon Peabody LLP, are cooperating attorneys volunteering countless hours and expertise on the case.

“We are very pleased that the court struck down the unconstitutional legislation and regulation preventing transgender Iowans from receiving Medicaid coverage for medically necessary gender-affirming surgery,” said Attorney Seth A. Horvath. “The court’s decision will have a direct positive effect on the lives of our clients. It’s a great privilege for Nixon Peabody to continue to partner with the ACLU in handling this important litigation.”

Read the official court order here.