Media Contact

Cindy Garcia, ACLU of Iowa Communications Manager

May 12, 2023

Des Moines, Iowa — The Iowa Supreme Court today left intact a district court’s ruling upholding coverage for gender-affirming care in Iowa’s Medicaid program.

The district court’s previous ruling, which was left in effect by today’s decision, found an amendment to the Iowa Civil Rights Act to take away nondiscrimination protections for transgender Iowans on Medicaid who need gender-affirming care unconstitutional. It also ruled that an Iowa Medicaid regulation barring coverage of gender-affirming care was unconstitutional, determining both violated the state constitution’s guarantee of equal protection of the law.

The Iowa Supreme Court dismissed the state's appeal of the district court’s decision regarding the amendment to the ICRA, because it determined the appeal is moot.

It is the latest chapter in a long history of litigation where courts have repeatedly affirmed the rights of transgender Iowans to medically necessary gender-affirming care and then the state has taken unconstitutional and discriminatory action to block access to that care. 

The decision today preserves the district court win for our clients back in November 2021. The court affirmed that Iowa Medicaid must not rely on the discriminatory regulation or statute to withhold coverage of medically necessary gender-affirming care to transgender Iowans on Medicaid. This was crucially important, since gender-affirming care for them and many other transgender people is life-saving care.

The district court in its decision specified that Iowa Medicaid must not deny coverage of medically necessary gender-affirming care, because doing so violates 1) the Iowa Constitution, which requires equal protection of the laws for all Iowans and 2) the Iowa Civil Rights Act, which includes specific protections against discrimination based on gender identity.

It is the second part of that decision—the part regarding the Iowa Civil Rights Act—that the state appealed to the Iowa Supreme Court. (In 2019, the Iowa Legislature changed the Iowa Civil Rights Act to specifically take away the nondiscrimination protections and statutory remedies covering transgender Iowans on Medicaid.)

Today, the Iowa Supreme Court dismissed the state’s appeal. 

Statement from Aiden Vasquez (pronounced Vas-KEZ)

“This has been a long, incredibly difficult fight for the last four years of my life. But I am proud to be a part of this history-making litigation and proud to be standing up for the justice of all transgender Iowans and hope to set a precedent for other states to do the same.

"For me and many others, being transgender is not easy and something that many other people may not yet understand. My gender dysphoria means I have a body that doesn’t match who I know I am—a man. This is made worse by a society that labels me as wrong or sinful, mentally ill, or odd, which is not the case.

"Because of this, transgender people are continuing to be discriminated against and their civil rights threatened. This is something that doesn’t just affect me. I have spoken to thousands of transgender people, moms, dads, family members. The stories of hate, suicidal ideation and attempts, the loss of a child and parents, misunderstandings and unequal treatment of transgender people, breaks my heart—along with the denial of healthcare I’ve received.

“I am glad the decision from the district court is still the law because this ban has prevented many transgender people form getting necessary care. Our society is slowly realizing that everyone deserves to be treated with respect, dignity and allowed healthcare and equal opportunities.”

Statement from Mika (pronounced MIKE-uh) Covington

“It was so devastating when the Iowa Legislature changed our civil rights act to take away that equal treatment for transgender people on Medicaid. The district court returned things to the fair way it used to be since the ban on Medicaid covering this care was first invalidated in the Good case.

“I am so glad that the decision from the district court saying the ban on gender-affirming care in Medicaid is unconstitutional is still in place.

“This litigation has been a long and difficult journey. I am glad that Iowa Medicaid can no longer enforce the rule that specifically prohibits transgender people from getting certain types of surgery, including surgery they would cover for people who are not transgender. That's the way it should be when it comes to medically necessary care. A person needs surgery, recommended by their doctor, and insurance pays for it.”

Statement from Seth Horvath, cooperating attorney with Nixon Peabody in Chicago

“Today’s decision leaves in place a well-reasoned district-court injunction finding that denying Medicaid coverage for gender-affirming surgery is illegal and unconstitutional in Iowa. The lower courts have now spoken twice on these issues. Both times they’ve found that limiting access to medically necessary surgical care violates the rights of transgender Iowans.

“Our clients are grateful that they can proceed with the care they need. They’ve won a long, hard fight for their rights that started nearly four years ago. All Iowans can be appreciative that their court system protected those rights.”

Statement from ACLU of Iowa Legal Director Rita Bettis Austen

"We know that this care is literally lifesaving for people who need it. Today’s dismissal of the state’s appeal leaves intact the Iowa district court decision that ordered the state to allow our clients to finally get the gender-affirming surgical care that all their doctors agree is medically necessary for them.

"We are honored to represent Aiden and Mika 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 Iowa Supreme Court, in dismissing the state’s appeal, left in effect the critically important district court decision from November 2021 that 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 district court recognized the Good case applies. That is a prior Iowa Supreme Court decision which had already found that the regulation violates the legal protections against gender identity discrimination in the Iowa Civil Rights Act.

"The district 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.

We are celebrating the decision today, which leaves that lifesaving decision by the district court in effect.”


Photos of Aiden Vasquez and Mika Covington and other images can be found here.

The Iowa Supreme Court’s ruling can be found here.

The district order finding the statute and regulation barring coverage of gender-affirming care to be unconstitutional can be found here.