A Timeline of Litigation for Coverage of Gender-Affirming Transgender Surgery in Iowa

July 1, 2025: A new law went into effect that heartlessly removed gender identity from the Iowa Civil Rights Act. No one knows the full impact of this change. The courts, and, of course, impacted Iowans, will have to sort that out in the years to come. However, other important protections remain in place for transgender Iowans.

May 12, 2022: The Iowa Supreme Court left intact a district court’s ruling requiring coverage for medically necessary gender-affirming care in Iowa’s Medicaid program in our lawsuit brought on behalf of Mika Covington and Aiden Vasquez.

It stemmed from a November 2021 district court order (see below) that, rightly, required coverage of medically necessary, gender-affirming surgery to transgender Iowans in Medicaid. In addition, the court ordered the state to strike the discriminatory Medicaid rule barring coverage and stop using it to deny pre-authorization of gender affirming care. Through the litigation, Mika and Aiden were able to get the preapproval they needed for gender-affirming care.

The state appealed to the Iowa Supreme Court the portion of the decision that addressed the constitutionality of a 2019 law that amended the Iowa Civil Rights Act to take away the nondiscrimination protections under that statute covering transgender Iowans on Medicaid. That issue is important because the Iowa Civil Rights Act provides important additional rights and remedies on top of the Iowa Constitution.

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 former transgender employee Jesse Vroegh 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 ordered the state to stop its practice of denying coverage of medically necessary, gender-affirming surgery to transgender Iowans in Medicaid. This order remains in place.

April 2021: The state denied Medicaid coverage to Mika and Aiden. The ACLU of Iowa then filed 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 ruled that Mika and Aiden had 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 after the Iowa Legislature passed a bill to amend the Iowa Civil Rights Act to remove transgender protections, the ACLU of Iowa filed a lawsuit on behalf of transgender clients and Medicaid patients Mika Covington and Aiden Vasquez. The lawsuit sought to block the new, discriminatory law.

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

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

March 2019: The Iowa Supreme Court upheld the injunction and ruled 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 ruled in favor of Carol Ann and EerieAnna, and blocked the Iowa Medicaid ban under the Iowa Constitution’s equal protection guarantee and the Iowa Civil Rights Act. The state appealed.

September 2017: The ACLU of Iowa filed 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 filed 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.