Judge: Iowa Medicaid refuses illegal sex reassignment

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

Judge William Kelly ordered the Iowa Department of Social Services to cover sex reassignment surgeries when ordered to treat gender dysphoria, a psychological distress resulting from an incongruity between the sex assigned to the birth and gender identity. It often starts in childhood and some people may not experience it until puberty or much later, according to the American Psychiatric Association.

About 12 states exclude surgeries from Medicaid coverage, 18 specifically include gender-affirming care, and others do not.

The decision is a victory for Aiden Vasquez and Mika Covington, two Iowans represented by the Iowa ACLU.

Kelly said state and federal courts over the past 16 years have found that discrimination based on gender identity is a form of discrimination based on sex that is prohibited by civil rights laws. He also found that the law violated the equal protection clause of the state constitution.

There is no dispute in the record that surgical treatment for gender dysphoria is a serious medical problem and surgery is recommended for Vasquez and Covington by medical professionals as necessary and effective, the judge said. He said Medicaid coverage is fundamental to ensuring the availability of this treatment for economically disadvantaged Iowans.

“Once the medical community determined that surgery is medically necessary to treat this health problem, the government lost its rational basis for refusing to pay for the surgery,” Kelly said in a decision signed Friday but released publicly with court records online Monday. “The law seems to draw an arbitrary distinction. Thus, there is no plausible political reason advanced by, or rationally connected with, the exclusion of transgender people from Medicaid reimbursement for medically necessary procedures.

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

“It recognizes what we have known for a long time, that transgender people in Iowa should not be discriminated against and that they are protected by the equal protection guarantee of the Iowa Constitution, as well as the Iowa civil rights, ”Bettis Austen said.

The Iowa ACLU filed a lawsuit in April against the state of Iowa challenging a 2019 law that allows Medicaid to deny payment for sex reassignment surgeries for transgender residents.

Vasquez and Covington initially filed a lawsuit in 2017 and a state court judge found the policy violated Iowa civil rights law and the Iowa Supreme Court in 2019 confirmed this decision. The court found that Iowa’s Medicaid program cannot categorically discriminate against transgender people who seek medically necessary care and who are gender-affirming.

Shortly after the court ruling, Republicans in the Iowa Legislature passed an amendment as part of a last-minute addition to a social services budget bill in response to the ruling court. This change stipulated that any government agency in Iowa could refuse to use taxpayer money for “sex reassignment surgery” or “any cosmetic or reconstructive plastic surgery procedure related to transsexualism, hermaphroditism, gender identity disorder or body dysmorphia ”.

Vasquez and Covington, however, had to take their case to the Department of Social Services’ system and seek surgery, be denied on the basis of the new law, and then sue again in court. Iowa DHS has since denied them any coverage. Vasquez is a transgender man who was diagnosed with gender dysphoria in 2016 and Mika Covington is a transgender woman who was diagnosed with gender dysphoria and started receiving hormone therapy in 2015.

Gov. Kim Reynolds enacted the bill in May 2019, arguing that it closely clarifies that Iowa’s civil rights law does not require taxpayer money to pay for gender reassignment and other similar surgeries.

Reynolds spokeswoman Alex Murphy said she was disappointed with the decision “and disagreed with the district court’s ruling on Medicaid coverage for transgender reassignment surgeries.” We review the decision with our legal team and explore all options for moving forward. ”

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