Iowa Law Denying Medicaid Funding Of Gender Affirming Surgery Is Unlawful: Judge

DES MOINES, Iowa (AP) — An Iowa law that prohibits Medicaid coverage for sex reassignment surgeries for transgender residents violates state law and the state constitution, a judge ruled in a decision made public Monday.

Judge William Kelly ordered the Iowa Department of Human Services to provide coverage for sex reassignment surgeries when ordered to treat gender dysphoria, a psychological distress that results from an incongruence between one’s sex assigned at birth and one’s gender identity. It often begins in childhood, and some people may not experience it until after puberty or much later, according to the American Psychiatric Association.

About 12 states exclude the surgeries in Medicaid coverage, 18 specifically include gender-affirming care and others do not address it.

The ruling is a victory for Aiden Vasquez and Mika Covington, two Iowans represented by the ACLU of Iowa.

Kelly said state and federal courts in the past 16 years have found that gender identity discrimination is a form of sex discrimination which is prohibited under civil rights laws. He also found the law violated the equal protection clause of the state constitution.

It is not challenged in the record that surgical treatment for gender dysphoria is a serious medical condition and the surgery is recommended for Vasquez and Covington by medical professionals as necessary and effective, the judge said. He said Medicaid coverage is fundamental to ensure the availability of that treatment for economically disadvantaged Iowans.

“Once the medical community determined that surgery is medically necessary to treat this health issue, the government lost its rational basis to refuse to pay for the surgery,” Kelly said in a ruling signed on Friday but posted publicly with online court records on Monday. “The law appears to draw an arbitrary distinction. So, there is no plausible policy reason advanced by, or rationally related to, excluding transgender people from Medicaid reimbursement for medically necessary procedures.”

Rita Bettis Austen, legal director of the ACLU of Iowa, called the decision “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,” Bettis Austen said.

The ACLU of Iowa filed a lawsuit  in April against the state of Iowa challenging a 2019 law that allows Medicaid to deny payment for sex reassignment surgeries for transgender residents.