FILE: Rita Bettis Austen, Legal Director of the American Civil Liberties Union of Iowa speaks at a Des Moines news conference on May 15, 2018. In a Monday decision, the judge declared that an Iowa law banning Medicaid coverage of sex reassignment procedures for transgender residents was against both state law and state constitution. Bettis Austen believes it is a landmark victory for Iowa civil rights. Gov. Kim Reynolds said she is not satisfied with the ruling of the district judge and that she will be exploring other options. (AP Photo/Charlie Neibergall, File)
Source: Associated Press

DES MOINES, Iowa (AP) — An Iowa law that prohibits Medicaid coverage for sex reassignment surgeries for transgender residents violates state law and the state constitution, a judge ruled in a decision made public Monday.

Judge William Kelly ordered the Iowa Department of Human Services to provide coverage for sex reassignment surgeries when ordered to treat gender dysphoria, a psychological distress that results from an incongruence between one’s sex assigned at birth and one’s gender identity. The American Psychiatric Association states that it can often begin in childhood. However, some individuals may experience it later or even after puberty.

Around 12 states do not cover surgeries under Medicaid. 18 include specific gender affirming care, while others don’t.

This ruling was a win for Aiden Vasquez, Mika Covington and Mika Corbin who are two Iowans representing the ACLU of Iowa.

Kelly stated that federal and state courts have held in the 16-year history of Kelly’s case found gender identity discrimination to be a form sex discrimination, which is against civil rights laws. Kelly also found that the law was in violation of the Equal Protection Clause in the state constitution.

The judge stated that the fact that gender dysphoria surgery can be performed is undisputed. He also said that Vasquez or Covington are recommended by doctors as needed and efficient. To ensure that Iowans with economic disadvantage have access to this treatment, he said Medicaid coverage was essential.

“Once the medical community determined that surgery is medically necessary to treat this health issue, the government lost its rational basis to refuse to pay for the surgery,” Kelly said in a ruling signed on Friday but posted publicly with online court records on Monday. “The law appears to draw an arbitrary distinction. So, there is no plausible policy reason advanced by, or rationally related to, excluding transgender people from Medicaid reimbursement for medically necessary procedures.”

Rita Bettis Austen, legal director of the ACLU of Iowa, called the decision “a historic win for civil rights” in Iowa.

“It recognizes what we’ve long known, that transgender Iowans must not be discriminated against, and that they are protected by the Iowa Constitution’s guarantee of equal protection, as well as by the Iowa Civil Rights Act,” Bettis Austen said.

ACLU of Iowa filed a lawsuitIn April, the Iowa State Department challenged a law in 2019 that allowed Medicaid to refuse payment for transgender residents sex reassignment surgery.


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