Media Contact

Veronica Lorson Fowler, ACLU of Iowa Communications Director


November 23, 2021

Des Moines, Iowa — A court struck today struck down as unconstitutional the State of Iowa's practice of singling out transgender Iowans in Medicaid by denying them coverage of medically necessary, gender-affirming surgery.

Rita Bettis Austen, ACLU of Iowa Legal Director, said, "This is a historic win for civil rights in Iowa. 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."

The win follows a five-year struggle to secure equal Iowa Medicaid coverage of healthcare for transgender Iowans. The ACLU previously filed litigation in 2017 to block an Iowa Medicaid regulation that prevented the coverage. Courts affirmed that the care must be provided in 2019. But only two months later, the Iowa Legislature responded by passing a new law that specifically carved out discrimination against transgender Iowans in Medicaid coverage access from the Iowa Civil Rights Act protections in order to reinstate the earlier Medicaid regulation.

In resolving the lawsuit brought on behalf of Iowans Mika Covington and Aiden Vasquez (vass-kez), the district court found that 1) the Iowa law singling out and blocking medically necessary care for transgender Iowans in Medicaid was discriminatory and unconstitutional and 2) the Iowa Medicaid rule that also singled out and blocked medically necessary transgender care was discriminatory, unconstitutional, and a violation of the Iowa Civil Rights Act.

There is consensus among every mainstream medical association, including the American Medical Association, that gender-affirming surgery is necessary, effective, life-saving care for some people suffering from gender dysphoria.

Quote from Aiden Vasquez of southwest Iowa (photo available in link below)

"I am so glad to be able to take the next step forward. I desperately need this surgery. For me, it's nothing short of life-saving. The fact that I have had to jump through hoops and just to try to get coverage for a surgery that could save my life has been mentally, emotionally, and physically draining. It is very hard for me to know that the state has gone out of its way to discriminate against me just because I'm transgender.

"I would like everyone to understand that this is not cosmetic surgery. It is not a whim. This has affected my whole life in a negative way and has affected my well-being. Not all transgender people need surgery, but I do. I am a man, but I was born into a body that I experience as not being who I am without this surgery.

That’s why this surgery will be life-changing. I have seen too many other transgender people suffer because they can't get the care they need. I'm doing this for them, too."

Quote from Mika Covington of central Iowa (photo available in link below)

“This is an emotional day for me. I have been suffering in this body and with gender dysphoria for so long. As with so many other transgender people, because of the lack of medical care, this has been so heavy on me mentally and physically.

"This care will be life-saving for me because I’m constantly bombarded every day with giving up, with suicidal thoughts, and thoughts of self-harm. The way transgender people are treated in our society and the way they are denied care is deeply painful. I am so glad we have gotten this recognition of the fundamental right of transgender people for medically necessary care. It's a huge step forward.

"This is so important because it affects the lives of so many transgender people in Iowa. Days like today make me proud to be an Iowan."

Additional quotes from Rita Bettis Austen, ACLU of Iowa Legal Director

"We are so relieved for our brave clients that the court has ordered the state to allow them to finally get the gender-affirming surgical care that all their doctors agree is medically necessary for them. We are honored to represent them and the transgender clients who have come before them in this fight, in their long journey for themselves and for all other transgender Iowans to be treated equally and fairly under the law.

"Today, the district court held that the Iowa Medicaid regulation, which singles out only transgender people from receiving medically necessary surgery, is discriminatory and violates the Iowa Constitution’s guarantee of equal protection. In addition, the court recognized the Good case applies, which already found that the regulation violates the legal protections against gender identity discrimination in the Iowa Civil Rights Act. The court also found unconstitutional the 2019 Iowa statute attempting to amend the Iowa Civil Rights Act to specifically take away the right to nondiscrimination in Medicaid which had been in place since 2007, restoring the Iowa Civil Rights Act. The Iowa Legislature had passed that law to take away the right to nondiscrimination in Medicaid for transgender Iowans after the Iowa Supreme Court struck down the regulation under the Iowa Civil Rights Act the first time in 2019. Accordingly, the district court’s ruling today ordered the state to reverse its previous denial of coverage for medically necessary care to our clients, Aiden and Mika, so that they can get the surgeries they need."

For more information on this lawsuit, click here.

The lawsuit was filed by the ACLU of Iowa and the national ACLU LGBTQ & HIV Project. Attorneys Seth A. Horvath, Tina B. Solis, and F. Thomas Hecht, Litigation Partners at the Chicago office of the national firm Nixon Peabody LLP, are cooperating attorneys volunteering countless hours and expertise on the case.

Quote from John Knight, Senior Staff Attorney, ACLU LGBT & HIV Project

"The blatant attack on transgender Iowans that made this case necessary is part of a nationwide effort to use transgender people as political scapegoats. Aiden and Mika are two heroic transgender Iowans who join a vast group of courageous transgender people and their allies in Iowa and elsewhere who are fighting back. This win is theirs above all else. The district court’s decision recognizes the humanity of our transgender colleagues, friends, and community members as well as their entitlement to basic fairness. We should expect nothing less."

Quote from Seth Horvath of Nixon Peabody

"We are very pleased that the court struck down the unconstitutional legislation and regulation preventing transgender Iowans from receiving Medicaid coverage for medically necessary gender-affirming surgery. The court’s decision will have a direct positive effect on the lives of our clients. It’s a great privilege for Nixon Peabody to continue to partner with the ACLU in handling this important litigation."

The court order is here.

Photos of Aiden and Mika, taken by and property of the ACLU of Iowa, are available for public use in the media, are here.