Iowa justices decide transgender care still covered by Medicaid

DES MOINES — Transgender rights advocates celebrated an Iowa Supreme Court decision Friday to leave in place a lower-court ruling that a 2019 amendment to the Iowa Civil Rights Act is unconstitutional.

The Iowa Supreme Court declined to offer its own ruling on the constitutionality of 2019 legislation that stated the Iowa Civil Rights Act does not require state or local governments to provide for gender transition surgery, calling the question “moot.”

A district court in 2021 ordered the state to stop its practice of denying gender transition treatment to transgender Iowans on Medicaid, ruling the proposed change to the Iowa Civil Rights Act violated the guarantee of equal protection under the Iowa Constitution.

The state appealed that decision to the Iowa Supreme Court, which on Friday declined to offer its own opinion, leaving the district court ruling in place.

“The importance of this truly cannot be overstated and we are celebrating today,” Rita Bettis Austen, the legal director for ACLU of Iowa, said in a news conference Friday.

“Transgender Iowans on Medicaid can continue to receive the coverage for lifesaving, gender-affirming care that they desperately need,” she said. “As the district court ruled, the state cannot enforce its discriminatory regulation to bar this coverage.”

The ACLU of Iowa represented the plaintiffs in the case that produced Friday’s opinion

The Supreme Court’s unanimous opinion, written by Justice Thomas Waterman, said the court declined to offer its own opinion of whether the changes made to the Iowa Civil Rights Act were unconstitutional because, in the case before them, the issues had been resolved — the state has complied with the lower court ruling and has paid for gender-transition treatments for Medicaid recipients, even while appealing that lower court ruling.

“Choices have consequences, and in this case, the appellant’s choices prompt us to dismiss its direct appeal as moot,” Waterman’s opinion for the court says.

The Supreme Court also declined to weigh in, the opinion said, because the case record is insufficient to make such a determination and because national case law on transgender rights is in flux.

“The issues concerning Medicaid coverage for adult sex reassignment surgery are of public importance and likely to recur, but not in a manner that will evade appellate review,” Waterman wrote. “For several reasons, this case is a poor vehicle for a precedential decision on the constitutionality” of the proposed amendment to the Iowa Civil Rights Act.

The ACLU of Iowa filed a lawsuit on the behalf of plaintiffs Aiden Vasquez and Mika Covington in May 2019, shortly after the Republican-led Iowa Legislature passed the provision that said the state is not required to fund gender transition care.

The ACLU argued the care was necessary and prescribed by Vasquez’s and Covington’s physicians.

“This litigation has been a long and difficult journey for me,” Covington said. “I am glad that Iowa Medicaid can no longer enforce the rule that specifically prohibits transgender people from getting certain types of surgery, including surgery they would cover for people who are not transgender.

“That’s the way it should be when it comes to medically necessary care: A person needs surgery recommended by their doctor, and insurance pays for it.

“I hope that moving forward for all the transgender people who come after me that all this litigation means that finally they can get the care they need without judgment and unfair roadblocks.”

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