The Iowa Department of Human Services (DHS) is appealing a Polk County District Court ruling that found the state law and policy designed to deny Medicaid coverage for gender-affirming surgery are unconstitutional. The state filed notice of its intent to appeal on December 17, near the end of its 30-day window to do so following the District Court’s decision in November.
The Iowa Attorney General’s office had no comment on the appeal. Governor Kim Reynolds’ office also had no comment on why the governor is determined to prevent transgender Iowans on Medicaid from receiving medically necessary care approved by their doctors.
Plaintiffs Aiden Vasquez and Mika Covington have been waiting for years to obtain surgery and first challenged the state law in court within weeks of Reynolds signing the provision into law in May 2019.
Polk County District Court Judge William Kelly determined that Iowa’s law and an associated DHS regulation violate the Iowa Constitution’s equal protection clause. He ordered DHS to change its longstanding rule “excluding coverage for sex reassignment surgery” for the treatment of gender dysphoria.
As Bleeding Heartland discussed in detail here, the District Court found the law and policy unconstitutional under the less demanding “rational basis” standard as well as the heightened scrutiny it would likely receive on appeal to the Iowa Supreme Court. Although the judge did not find that the law and policy “were motivated by animus toward transgender people,” he concluded that “there is no plausible policy reason advanced by, or rationally related to, excluding transgender people from Medicaid reimbursement for medically necessary procedures.”
Attorneys for the state have not yet filed a brief outlining the arguments they will make on appeal. But by giving notice that DHS will appeal, the state has likely forced Vasquez and Covington to wait for many more months to receive medical care that could improve their overall health and reduce their anxiety or depression.
Legal director Rita Bettis Austen of the ACLU of Iowa, which is representing Vasquez and Covington, said in a December 20 statement to Bleeding Heartland, “We look forward to making our case on appeal to continue to block this cruel and discriminatory policy.”
Disclosure: The ACLU of Iowa is also representing Laura Belin, Bleeding Heartland, and other plaintiffs who recently sued Governor Kim Reynolds over open records law violations.