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

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

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.

The Iowa Supreme Court upholds a $120,000 jury award and finds 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.

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.

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

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.

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.

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.

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.

In 2019, a Polk County District Court jury rules in favor of Jesse Vroegh, awarding him $120,000 in damages. It finds that the state had engaged in sex and gender identity discrimination, which is prohibited by the Iowa Civil Rights Act. It also finds 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.

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.

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

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

The ACLU of Iowa files 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 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.