Des Moines, Iowa — Today the ACLU filed a new lawsuit to strike down as unconstitutional the state’s practice of denying Medicaid coverage for medically necessary, gender-affirming surgery to transgender Iowans.
The lawsuit was filed by the ACLU of Iowa and the national ACLU LGBTQ & HIV Project on behalf of Aiden Vasquez (vass-kez). This lawsuit follows an earlier, similar lawsuit by Aiden and Mika Covington that also asked the courts to declare the state's practice of denying coverage unconstitutional.
Both Mika, who lives in central Iowa, and Aiden, who lives in southeast Iowa, are transgender and qualify for Medicaid. Their doctors agree strongly that they need gender-affirming surgery to treat gender dysphoria.
That earlier lawsuit made it to the Iowa Court of Appeals, which dismissed the case on procedural grounds because Aiden and Mika hadn't first sought and been denied coverage by the Iowa Department of Human Services. (DHS has now denied that coverage to Aiden, so a new lawsuit can proceed. Mika’s case is still before DHS. If it denies her coverage too, she’ll join this litigation by filing a petition for judicial review in the district court.)
Statement by Rita Bettis Austen, ACLU of Iowa Legal Director
"The ACLU will keep working in the courts to strike down the discriminatory rule and the statute that reinstated it. As the Polk County District Court found in 2018 in the Good-Beal case, the state’s policy of denying transgender people coverage for medically necessary gender-affirming surgery is a clear violation of equal protection under the Iowa Constitution because it facially and intentionally discriminates against people simply because they are transgender.
"We know Iowans, especially transgender Iowans, are tired of the state continuing these discriminatory denials, forcing us to litigate this issue over and over again. But the ACLU is committed to fighting this discrimination as long as it takes to ensure a fair Medicaid system that treats everyone the same.”
"This law brings significant harm to our clients and others who rely on Medicaid and who desperately need this surgery. This law 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."
"The consensus among major medical associations is that gender dysphoria is a serious medical condition and that surgical treatment is medically necessary for some transgender people."
Aiden Vasquez Statement
"I desperately need this surgery. 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.
"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.
"I am also involved in this lawsuit to help others. I hope that in suing to get the care I need, we will succeed in forcing the state to do the right thing and end this discriminatory ban so that everyone who needs it can get medically necessary gender-affirming surgery."
Mika Covington Statement
“I am a University of Iowa student, studying psychology and German. I am also on the patient advisory board of the University of Iowa Hospitals and Clinics. It becomes increasingly clear to me: All Iowans, regardless of income level, have the right to have medically necessary health care without discrimination. It's wrong to deny Iowans on Medicaid like me their medically necessary care just because we are transgender.
"It's been more than a decade since I have come out as transgender, though I have known I am female long before that. I am currently forced to live in a body that does not align with my gender, the gender that I am in my mind and in my heart. It affects every aspect of my life, creating tremendous stress that triggers anxiety attacks, anguish, and other health problems. This surgery is literally life-saving for me.
"Being able to finally get the surgery that my doctors have determined is medically necessary for me will do nothing less than give me my life back. It will help me build a life in which my body is in harmony with my gender, so I can overcome the depression, lack of confidence, isolation, and other problems my gender dysphoria causes."
Click here for a timeline of this and related ACLU transgender lawsuits in Iowa.
Statement from Courtney Reyes, Executive Director of One Iowa
"Everyone in our communities should be able to access the medically necessary care their doctor has prescribed for them, and that includes individuals who are transgender. It can be hard to understand what it means to be transgender, especially if you’ve never met a transgender person.
"Transgender Iowans are our friends, family members, and co-workers, and they deserve to be treated with dignity and respect when accessing necessary care. We are proud to support the ACLU of Iowa as it works on behalf of Mika and Aiden, and we are hopeful the court will grant them the equal access they so clearly deserve."
Acknowledgments and More Information
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.
The complaint was filed today with the Polk County District Court Clerk's office. However, it is not yet official and we cannot share it until it has been accepted and stamped. If you would like to receive a copy as soon as possible, please let us know and we'll email it to you.
Photos of Aiden and Mika, taken by and property of the ACLU of Iowa, are available for public use in the media, are here.