Judge says Iowa cannot ban Medicaid for sex reassignment surgery

A judge has ruled that an Iowa law banning Medicaid coverage for gender-affirming sex reassignment surgery violates state law and the state constitution. 

In a decision released Monday, Judge William Kelly is requiring the Iowa Department of Human Services to offer Medicaid coverage for sex reassignment surgeries for transgender residents of the state, The Associated Press reported. 

The ruling follows a nearly five-year process of trying to secure Medicaid access for transgender residents, the American Civil Liberties Union (ACLU) of Iowa said in a press release. The group first filed litigation in 2017 on behalf of two Iowans, Aiden Vasquez and Mika Covington, to fight a state regulation preventing the coverage. Courts determined that the state must cover the surgeries in 2019.

However, a couple months later, the Iowa legislature passed a law allowing Medicaid to deny coverage for sex reassignment surgeries, according to the AP, leading the ACLU of Iowa to bring the case back to court.

“This is a historic win for civil rights in Iowa,” Rita Bettis Austen, the legal director of the ACLU of Iowa, said in the group’s press release. “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.” 

Kelly determined that the Iowa law was a violation of state constitution’s equal protection clause. He also noted that state and federal courts have acknowledged over the past 16 years that discrimination on the basis of gender identity violates civil rights laws barring sex discrimination.

“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 the ruling, the AP reported. “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.”

Per the AP, a spokesman for Iowa Gov. Kim Reynolds (R) said Reynolds is disappointed with Kelly’s ruling “and disagrees with the district court’s ruling on Medicaid coverage for transgender reassignment surgeries.”

“We are reviewing the decision with our legal team and exploring all options moving forward,” the spokesperson added.