On May 31st, 2019, the ACLU of Iowa and National ACLU LGBTQ and HIV Project filed a lawsuit to block implementation of an Iowa law that was recently passed to restore the ban on Medicaid coverage for essential, gender-affirming surgery to transgender Iowans that the Iowa Supreme recently struck down.

In May 2023, the American Civil Liberties Union and the ACLU of Nebraska filed a lawsuit on behalf of Nebraska abortion providers and their patients challenging a state law that bans physicians from providing abortion after 12 weeks of pregnancy and that, as of October 2023, will restrict health care available to trans youth. The ACLU has asked a state court in Nebraska to enter an emergency order blocking the law’s enforcement. The Court ruled that the two halves of L.B. 574 fall within the single subject of regulating health care, and thus the Court held that L.B. 574 does not violate the single-subject rule. Consequently, the abortion ban and gender-affirming care restrictions in L.B. 574 remain in effect. However, the Court did reject the state’s argument that the single-subject is a nonjusticiable political question.

Xavier Hersom applied for and was denied a gender marker change on his birth certificate. He said DHHR’s policy has created yet another layer of difficulty for him as a transgender person living in West Virginia. The ACLU, the ACLU of West Virginia, and the Harvard Law School LGBTQ+ Advocacy Clinic filed a federal lawsuit asking a court to declare West Virginia’s birth certificate policies relating to transgender people unconstitutional on behalf of Hersom and an another anonymous plaintiff.

The American Civil Liberties Union Foundation of Northern California, the American Civil Liberties Union Foundation of Southern California and Rukin Hyland & Riggin LLP filed a lawsuit on March 21, 2019 on behalf of Oliver Knight, a 29-year-old transgender man who was denied surgery minutes before it was scheduled to take place based on the hospital’s religious beliefs, which do not recognize gender-affirming care.