ACLU of Iowa again sues state for exemption to transgender-related services

Iowa law passed in response to Supreme Court ruling earlier this year

Aiden Vasquez
Aiden Vasquez

The American Civil Liberties Union of Iowa again has filed suit against an Iowa law that bars Medicaid coverage for transgender individuals.

The ACLU of Iowa, along with the national ACLU LGBT and HIV Project, filed the lawsuit Friday to block implementation of a law passed in the final days of the 2019 Legislative Session.

The suit was filed on behalf of LGBTQ advocacy organization One Iowa and two transgender Iowans — Mika Covington of central Iowa and Aiden Vasquez of southeast Iowa.

Under an amendment added to the health budget bill, government entities are prohibited from using public insurance dollars for sex-reassignment surgeries or “any other cosmetic reconstructive or plastic surgery procedure related to transsexualism, hermaphroditism, gender identity disorder or body dysmorphic disorder.”

The law says the state’s civil rights protections do not require government health care programs to cover sex-reassignment surgery, meaning Iowans such as Covington and Vasquez who qualify for Medicaid will be unable to obtain Medicaid coverage for the procedure.

The provision was passed by the Republican-controlled Legislature as a response to an Iowa Supreme Court ruling in March, which came about from an ACLU lawsuit. The justices had affirmed a district court judge’s ruling that Medicaid must cover sex-affirming surgeries under the gender-identity protections within the Iowa Civil Rights Act.

In April, state lawmakers passed the legislation that amended the Iowa Civil Rights Act, creating the exception to public accommodations for transgender individuals. Gov. Kim Reynolds signed it into law in early May and the law went into immediate effect.


“This law reverts the state of Iowa back to its long-standing discriminatory policy and practice of denying transgender Iowans on Medicaid coverage for gender-affirming surgery,” ACLU of Iowa Legal Director Rita Bettis Austen said. “The law brings significant harm to our clients and others who rely on Medicaid and who desperately need this surgery.”

According to an ACLU news release, Covington and Vasquez seek sex-reassignment surgeries to treat gender dysphoria, a condition in which an individual experiences distress because the gender they were assigned at birth does not match his or her gender identity.

In a statement, Vasquez said he is participating in the suit to get the medical care he “desperately” needs to align his body with his gender.

Covington echoed Vasquez’s comments in the statement, saying it is difficult “to live in a body that does not align with the gender you are in your heart and your mind.”

“Gender-affirming surgery is not cosmetic surgery,” Covington said. “Getting the gender-affirming surgery that my doctors have determined is medically necessary for me will do nothing less than give me my life back. It will help me build a life in which my body is in harmony with my gender so I can overcome the depression, lack of confidence, isolation, and other problems my gender dysphoria causes.”

The Iowa Department of Human Services, which oversees Medicaid, declined to comment due to pending litigations.

“We will work with the Iowa Attorney General’s Office to defend this narrow provision clarify-ing that Iowa’s Civil Rights Act does not require taxpayer dollars to pay for sex reassignment and other similar surgeries — the state’s position for years,” Pat Garrett, spokesman for the Governor’s Office, said late Friday in an email.

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