Iowa Sued Over Ban on Medicaid Funds for Sex-Change Surgery

DES MOINES, Iowa (CN) – Two transgender Iowans and a gay rights group backed by the American Civil Liberties Union filed a lawsuit Friday challenging the constitutionality of a new state law barring Medicaid coverage for sex-reassignment surgeries.

The law, passed on the final day of the Iowa Legislature’s session and tacked on to a 108-page appropriation bill, was in response to a unanimous March 8 ruling from the Iowa Supreme Court striking down a state Department of Human Services rule excluding sex-reassignment surgeries from Medicaid coverage. The state’s high court said the rule violated the Iowa Civil Rights Act, which includes gender identity among the protected characteristics.

Transgender woman Mika Covington, one of the plaintiffs in a lawsuit filed Friday, challenging an Iowa law barring Medicaid coverage for sex-reassignment surgeries. (Photo via ACLU)

In response to that ruling, state lawmakers amended the Iowa Civil Rights Act to say, “This section shall not require any state or local government unit or tax-supported district to provide for sex reassignment surgery or any other cosmetic, reconstructive, or plastic surgery procedure related to transsexualism, hermaphroditism, gender identity disorder, or body dysmorphic disorder.”

Friday’s lawsuit was filed in Polk County District Court on behalf of Mika Covington, Aiden DeLathower aka Aiden Vasquez and One Iowa, a nonprofit that advocates for LGBTQ Iowans. The plaintiffs are represented by Rita Bettis Austen, legal director of ACLU-Iowa, and John Knight of the ACLU Foundation LGBT & HIV Project.

At a press conference Friday, Bettis Austen described the legislation as “outrageously, dangerously creating an exception to the Iowa Civil Rights Act protections against nondiscrimination that all Iowans enjoy, but specifically carving out transgender Iowans from that nondiscrimination protection and their ability to get medically necessary care through Iowa Medicaid.”

The complaint names as defendants Iowa Governor Kim Reynolds, a Republican, and the Department of Human Services. A spokesman for the governor did not immediately respond to a request for comment Friday.

When the governor signed the bill May 3, her spokesman said, “This narrow provision simply clarifies that Iowa’s Civil Rights Act does not require taxpayer dollars to pay for sex reassignment and other similar surgeries. This returns us to what had been the state’s position for years.”

Covington, one of the plaintiffs, said at Friday’s press conference, “It’s been a decade since I have come out as a transgender woman, though I have known I was female long before that. Those who are not transgender often do not understand what it is like to live in a body that does not align with the gender you are in your heart and your mind. It affects every aspect of my life.”

Sex reassignment is not a 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,” she 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.”

According to the ACLU’s lawsuit, the standards of care for treating gender dysphoria set forth in the World Professional Association of Transgender Health are recognized as authoritative by the American Medical Association, American Psychiatric Association, and American Psychological Association, among others.

Those medical associations “agree that gender dysphoria is a serious medical condition and that treatment for gender dysphoria is medically necessary for many transgender people,” the lawsuit states.  

The complaint argues that the state’s ban on Medicaid coverage of sex-reassignment surgery violates the petitioners’ rights of equal protection under the Iowa Constitution by “intentionally singling out transgender Iowans as a class for discrimination in public accommodations through the provision of publicly funded healthcare under the Iowa Civil Rights Act.”

It also challenges the manner in which the law was changed, saying lawmakers violated the state constitution because the bill pertains only to appropriations for health and human services and contains no notice in the title that it would create an exception to the Iowa Civil Rights act for transgender Iowans.

Besides urging a state judge to find the law unconstitutional, the lawsuit seeks temporary and permanent injunctions blocking enforcement of the new law.

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