Judge Tosses Challenge to Iowa Ban on Medicaid for Sex Reassignments

DES MOINES, Iowa (CN) – An Iowa judge dismissed a lawsuit brought by two transgender Iowans and a gay rights advocacy group challenging the constitutionality of a law that exempts sex-reassignment operations from coverage under the state’s Medicaid program.

Mika Covington, Aiden DeLathower aka Aiden Vasquez and One Iowa, a nonprofit that advocates for LGBTQ Iowans, argued in their May 31 complaint that the state’s ban on Medicaid coverage of sex-reassignment surgery violates their equal protection rights 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.”

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

Polk County District Judge David Porter dismissed the lawsuit on Thursday, finding the issues raised by the plaintiffs are not ready for judicial review.

Covington and Vasquez had not yet sought or been denied Medicaid coverage, so they must first appeal the state’s Medicaid rules at the administrative level before challenging them in court, he wrote in a 13-page order.

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

The plaintiffs were represented by Rita Bettis Austen, legal director of American Civil Liberties Union of Iowa, and John Knight of the ACLU Foundation LGBT & HIV Project.

A spokesperson for the ACLU-Iowa said the organization will now seek an emergency temporary injunction from the Iowa Supreme Court in response to Judge Porter’s dismissal of the suit.

The ACLU also released a statement Friday from Daniel Hoffman-Zinnel, executive director of One Iowa:  “No one, including transgender Iowans, should be denied the medical care they need. Being denied this medically necessary care puts the health and lives of transgender Iowans who rely on Medicaid at risk, including increased risk of depression, anxiety, and suicidal thoughts for transgender individuals who can’t access the care their doctors prescribe. That’s why we’re appealing this decision.”

This challenge to the constitutionality of Iowa’s Medicaid rules pertaining to sex-change surgeries is the second to work its way through Iowa’s courts. In March, the Iowa Supreme Court ruled unanimously that the DHS regulation barring Medicaid coverage of sex-change operations violated the Iowa Civil Rights Act. But the court did not reach the constitutional question of equal-protection violations.

The Iowa General Assembly then amended the Civil Rights Act to say that the act “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.”

In Thursday’s ruling, Judge Porter said the Civil Rights Act amendment does not “prevent the Iowa Medicaid program from covering sex reassignment surgery or any other surgical procedure, if the program so chooses.”

Covington and Vasquez must therefore begin by appealing to the DHS, which will give the state the opportunity to reconsider whether it will provide Medicaid coverage for sex-reassignment operations in the light of new scientific evidence since the original rules were written a quarter century ago.

“Unquestionably, petitioners make compelling arguments concerning the science and treatment related to gender dysphoria,” Porter wrote. “It is precisely because those arguments are compelling and because DHS has not reviewed or studied the language of the regulation since its original adoption in 1995 that the statute allows for interested persons, such as the petitioners here, to request the adoption, amendment, or repeal of a rule.”

That gives the administrative agency “a full opportunity to amend or repeal its rules related to treatment for gender dysphoria before those issues are presented to the district court,” he wrote.

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