A Polk County judge has ruled that a state law barring Medicaid coverage for gender-confirming surgery violates the state’s constitution and civil rights act. (Photo by Getty Images)
A Polk County judge has ruled that a state law denying Medicaid coverage for gender-confirmation surgery violates the Iowa Constitution and the Iowa Civil Rights Act.
A spokesman for Gov. Kim Reynolds said Monday the governor “is disappointed in today’s decision and disagrees with the district court’s ruling on Medicaid coverage for transgender reassignment surgeries.”
The spokesman said the governor’s staff is “reviewing the decision with our legal team and exploring all options moving forward.”
Polk County District Court Judge William Kelly ruled Friday that the element of the state law that excludes coverage for surgeries related to gender reassignment must be stricken from the Iowa Administrative Code, clearing the way for transgender Iowans to claim coverage for medically necessary operations to treat gender dysphoria and other diagnoses.
The ruling came in a lawsuit filed by the American Civil Liberties Union of Iowa and the national ACLU LGBTQ & HIV Project, which acted on behalf of Aiden Vasquez and Mika Covington, both of whom are transgender Iowans and Medicaid recipients.
Vasquez, Covington and the ACLU filed a similar suit in 2019 challenging the same law. The Iowa Court of Appeals dismissed that case because Vasquez and Covington had not yet been denied coverage by the Iowa Department of Human Services. Vasquez and Covington subsequently applied for and were denied coverage by the state agency.
Rita Bettis Austen, legal director for the ACLU of Iowa, said in a statement that she is gratified by the court’s decision.
“This is a historic win for civil rights in Iowa,” she said. “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 what the ACLU calls a “five-year struggle to secure equal Iowa Medicaid coverage of health care” for transgender Iowans.
The ACLU initiated litigation in 2017 to block an Iowa Medicaid regulation that sought to block such coverage. In 2019, the Iowa Supreme Court held that the coverage must be provided, in part because sexual orientation and gender identity were added to the Iowa Civil Rights Act as protected classes in 2007.
The court ruling prompted the Iowa Legislature to quickly approve a new law that specifically struck from the Iowa Civil Rights Act the prohibition against discrimination against transgender Iowans in Medicaid, effectively reinstating the ban on Medicaid coverage.
In his ruling, Judge Kelly stated the law singling out and blocking medically necessary care for transgender Medicaid beneficiaries was both discriminatory and unconstitutional.
“We are so relieved for our brave clients that the court has ordered the state to allow them to finally get the gender-affirming surgical care that all their doctors agree is medically necessary for them,” Bettis said. “We are honored to represent them and the transgender clients who have come before them in this fight, in their long journey for themselves and for all other transgender Iowans to be treated equally and fairly under the law.”
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