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ACLU Renews Lawsuit Over Iowa's Refusal to Cover Gender Surgery

Courtesy of the ACLU of Iowa
Aiden Vasquez is the plaintiff in a lawsuit with the ACLU of Iowa challenging the state's policy against covering gender-affirming surgeries through Medicaid.

A lawsuit filed Thursday by the ACLU of Iowa is the next step in an ongoing legal battle over the state's policy to not pay for gender-affirming surgeries through Medicaid, the state and federal program that provides health care for low-income individuals and families.

The suit was filed on behalf of Aiden Vasquez, a transgender man who was denied coverage by the Iowa Department of Human Services to have surgery to treat gender-dysphoria, a condition that can occur when a person’s biological sex differs from their gender identity.

The ACLU will argue that denying coverage for the procedure discriminates against Vasquez for being transgender and violates his equal protection rights under the Iowa Constitution.

“People who are on Medicaid are able to get coverage for medically necessary surgeries, unless they’re transgender and their surgery is to treat gender dysphoria,” ACLU of Iowa Legal Director Rita Bettis said during a press conference announcing the lawsuit.

Bettis said medical professional associations such as the American Medical Association and American Psychiatric Association have recommended covering gender-affirming procedures to reduce rates of depression and anxiety.

Vasquez said transgender people have suffered because they are not able to get the care they need.

“It’s hard knowing that the state has gone out of its way to discriminate against me and block my medical care just because I’m transgender when other Iowans on Medicaid are able to get coverage for the surgeries they need,” Vasquez said.

This is the third lawsuit against the Medicaid policy, according to Bettis.

In 2018, a Polk County District Court judge ruled in favor of a challenge from the ACLU on behalf of Carol Ann Beal and EerieAnna Good. That decision was upheld by the Iowa Supreme Court, but the Iowa Legislature then amended the Iowa Civil Rights Act so that public insurance programs, such as Medicaid, would not be required to pay for gender-affirming surgeries.

Credit Courtesy of the ACLU of Iowa
Mika Covington plans to join the ACLU lawsuit if her request for Medicaid coverage for gender-affirming surgery is denied.

Bettis said the change in the law is unconstitutional, “because it intentionally targets transgender Iowans and therefore it’s null and void.”

Aiden Vasquez was also a plaintiff in the ACLU’s second lawsuit against the state’s refusal to cover transgender surgeries, along with Mika Covington. The case was dismissed because their requests for coverage had not been officially denied.

Mika Covington currently has a case pending with DHS. She will join the lawsuit if the agency denies coverage for her surgery, as expected.

“This surgery is literally lifesaving for me,” Covington said. “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.”

Twenty-two states and the District of Columbia have specific policies that cover transgender-related care through their Medicaid programs, according to the Movement Advancement Project which tracks state policies related to LGBTQ equality.

Eleven states including Ohio, Missouri and Nebraska exclude transgender health care from Medicaid coverage. Iowa is not included in that list, the group says, because the recent change in law says the state “shall not require” coverage for gender-affirming procedures, but does not explicitly prohibit it as other states do.