Update on Medicaid coverage for medically necessary gender-affirming care: In November 2021, the Polk County District Court found that Iowa’s policy of denying coverage for medically necessary care for transgender Iowans on Medicaid is unconstitutional discrimination and a violation of the Iowa Civil Rights Act. As a result, it held that "the language of the Regulation excluding coverage for sex reassignment surgery for transsexualism shall be stricken from the Regulation and the remaining language must be interpreted and applied in a manner allowing transgender individuals coverage under Iowa Medicaid for medically necessary gender-affirming surgery for the treatment of Gender Dysphoria and other relevant diagnoses." You can read the order here.

The State has appealed but filed a brief that specifies that it is not appealing the portion of the district court's order finding that the regulation is a facial violation of the Iowa Constitution. Instead, it is expected to soon publish a new rule to regulate the coverage of gender-affirming surgery in Iowa Medicaid. 

The case is currently being briefed before the Iowa Supreme Court. The district court order finding the law discriminatory and unconstitutional remains in effect.

Briefing in the case will likely conclude in the summer of 2022. An oral argument is likely to be scheduled for fall or winter 2022. We will likely have a decision from the Supreme Court before the end of the Court’s 2022-23 adjudicative term (which ends on June 30, 2023). This is an estimated timeline within the discretion of the Court.

April 2022: In an April 2022 decision, the Iowa Supreme Court upheld a $120,000 jury award and found that the State had unlawfully discriminated against a former transgender employee by (1) denying him the use of the men’s restroom and locker rooms; and (2) by providing an employee health insurance plan that denied coverage for medically necessary gender confirmation surgery. 

November 2021: In the Medicaid lawsuit by Mika Covington and Aiden Vasquez, the court orders the state to stop its practice of denying coverage of medically necessary, gender-affirming surgery to transgender Iowans in Medicaid.

April 2021: The state has denied Medicaid coverage to Mika and Aiden. The ACLU of Iowa files a new lawsuit to stop the state’s practice of denying Medicaid coverage of medically necessary, gender-affirming surgery to transgender Iowans.

August 2020: The Iowa Court of Appeals rules that Mika and Aiden have not shown that Iowa Medicaid actually denied them coverage and that they must actually be denied the coverage before proceeding with a lawsuit.

May 2019: Just weeks later, the ACLU of Iowa files a lawsuit on behalf of transgender clients and Medicaid patients Mika Covington and Aiden Vasquez. The lawsuit seeks to block the new, discriminatory law.

May 2019: The Iowa Legislature, seeking to undo the Iowa Supreme Court decision, passes a bill that amends the Iowa Civil Rights Act to remove protections against discrimination for transgender people who rely on Medicaid in public accommodations.

The new law allows government entities to opt out of using public insurance dollars, including Medicaid, to pay for transition-related surgeries. Iowa Medicaid again begins enforcing its discriminatory ban against transgender Iowans, despite the prior injunction.

March 2019: The Iowa Supreme Court upholds the injunction and rules in favor of Carol Ann and EerieAnna again, addressing the lawsuit's Iowa Civil Rights Act claim but not ruling on its Iowa Constitutional claim.

February 2019: In 2019, a Polk County District Court jury ruled in favor of Jesse Vroegh, awarding him $120,000 in damages. It found that the state had engaged in sex and gender identity discrimination, which is prohibited by the Iowa Civil Rights Act. It also found that the State of Iowa’s health insurance plan for its employees violated the Iowa Civil Rights Act by explicitly excluding coverage for medically necessary gender-affirming surgery.

June 2018: The Polk County District Court rules in favor of Carol Ann and EerieAnna, and blocks the Iowa Medicaid ban under the Iowa Constitution’s equal protection guarantee and the Iowa Civil Rights Act. The state appeals.

September 2017: The ACLU of Iowa files a lawsuit on behalf of transgender clients Carol Ann Beal and EerieAnna Good to block an Iowa Medicaid ban for coverage of medically necessary gender-affirming surgery.

August 2017: The ACLU of Iowa files the first transgender rights lawsuit brought under the Iowa Civil Rights Act on behalf of Jesse Vroegh.

July 2016: The ACLU of Iowa filed a civil rights complaint on behalf of Jesse Vroegh. Vroegh, an Iowa nurse, was denied use of the men's restrooms and locker rooms solely because he is transgender by his then-employer the Iowa Department of Corrections. It had also denied him health care coverage for medically necessary treatment and procedures, even though the DOC provided coverage for similar procedures for non-transgender employees.