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Judge says Iowa can't ban Medicaid coverage of transition-related surgery

Mika Covington stands in dining room
Natalie Krebs
IPR File
An Iowa judge has ordered the state to reverse its denial of Medicaid coverage for Mika Covington's transition-related surgery.

An Iowa judge has ruled the state can no longer ban Medicaid coverage of transgender Iowans' medically necessary gender-affirming surgeries.

In a ruling dated Friday, Polk County District Court Judge William P. Kelly wrote Iowa’s law and Medicaid rule banning publicly-funded insurance coverage of gender-affirming surgery violate the equal protection clause of the Iowa Constitution and the Iowa Civil Rights Act.

The ACLU of Iowa sued on behalf of Aiden Vasquez andMika Covington after the state denied them Medicaid coverage for transition-related surgeries their doctors said were medically necessary. Judge Kelly has ordered the state to reverse those decisions.

“This is a historic win for civil rights in Iowa,” Rita Bettis Austen, ACLU of Iowa legal director, said in a statement. “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.”

In 2017, the ACLU of Iowa launched a legal challenge of the Medicaid rule that denied coverage of gender-affirming surgery. In 2019, an Iowa Supreme Court opinion said the rule violated the Iowa Civil Rights Act, which forbids discrimination based on gender identity.

Less than two months later, Republican state lawmakers added language to the Iowa Civil Rights Act to counteract the Iowa Supreme Court ruling. The law change blocked Medicaid coverage of transition-related surgery.

Republican Gov. Kim Reynolds signed that bill into law.

“The governor’s office is disappointed in today’s decision and disagrees with the district court’s ruling on Medicaid coverage for transgender reassignment surgeries,” spokesperson Alex Murphy said Monday. “We are reviewing the decision with our legal team and exploring all options moving forward.”

Next steps could include an appeal to a higher court.

Katarina Sostaric is IPR's State Government Reporter