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Iowa Sued Over Denial of Medicaid Coverage for Sex Reassignment

LGBTQ advocates say denying Medicaid coverage for gender-affirming surgeries for transgender Iowans violates the state’s constitution and civil rights law.

DES MOINES, Iowa (CN) --- The ACLU of Iowa claims in court that the state's policy of denying Medicaid coverage for sex-reassignment operations violates the equal protection provision of the state's constitution and the Iowa Civil Rights Act.

The lawsuit announced Thursday was filed by the ACLU of Iowa and the national ACLU LGBTQ & HIV Project on behalf of Aiden Vasquez, who lives in southeast Iowa. It is the ACLU’s third attempt to strike down as unconstitutional Iowa’s practice of denying what is known as gender-affirming surgeries for transgender people.

The first effort resulted in a 2019 Iowa Supreme Court ruling that the state’s policy violated the Iowa Civil Rights Act, but the court did not reach the constitutional question. The Iowa Legislature responded by amending the Civil Rights Act to remove protections against discrimination for transgender people who rely on Medicaid.

The ACLU of Iowa then filed its second suit raising the same constitutional question and seeking to block the amended version of the Civil Rights Act. That suit was dismissed by the Iowa Court of Appeals last August because the plaintiffs had failed to exhaust their claims before the state’s Department of Human Services, which decides state Medicaid claims.

The third suit, announced Thursday, follows the Iowa DHS decision denying coverage to Vasquez.

"I desperately need this surgery,” Vasquez said in a statement released by the ACLU Thursday. “Having to jump through so many hoops just to try to get coverage for the surgery has been mentally and emotionally very draining and difficult. 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."

He added, "I would like everyone to understand that we are not talking about cosmetic surgery or something superficial. This has affected my whole life in a negative way and has threatened my mental well-being. I am a man, but in a body that does not reflect who I am. That’s why this surgery will be life-changing. I have seen too many other transgender people suffer because they are unable to get the care they need."

The Vasquez complaint, which will not be released by the ACLU until it is publicly available on Iowa’s online court site, will argue that the state’s policy violates the Iowa Constitution’s equal protection provision by discriminating against Iowans just because they are transgender. The suit will also argue that the Iowa Legislature’s amendment to the Civil Right Act is itself unconstitutional because it denies Medicaid coverage for medically necessary medical procedures for one group of Iowans while approving them for others.

“This policy has no basis in medicine or science, and gender dysphoria is a serious medical condition that, in some cases, puts people at risk for death by suicide,” Rita Bettis Austen, ACLU of Iowa’s legal director, said at a news conference Thursday.

The medical consensus, including from the American Medical Association and other medical groups, is that this surgery is medically necessary for some transgender persons, Bettis Austin said, and Iowa is an outlier with its policy.

The Iowa Attorney General’s office declined to comment on the lawsuit Thursday.

Attorneys Seth A. Horvath, Tina B. Solis, and F. Thomas Hecht, litigation partners at the Chicago office of Nixon Peabody, are working with the ACLU on the case.

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