Vasquez v. Iowa Department of Human Services

The Iowa Supreme Court recently issued its opinion in Vasquez, ending the long saga of Iowa trying to exclude medically necessary gender-affirming surgery from Medicaid coverage. Previously, we prevailed in Good v. Iowa Dept. of Human Services, our challenge to Iowa’s ban on providing Medicaid coverage to transgender Iowans who need gender-affirming surgery. However, after winning that case under the Iowa Civil Rights Act (“ICRA”), the Iowa legislature amended that Act to take away protections for transgender people from the very kind of discrimination in access to public health care the Iowa Supreme Court had found to violate that statute one month before.

Following procedural appeals, we then challenged the denial of Medicaid coverage to Mika Covington and Aiden Vasquez challenging the amendment to the Iowa Civil Rights Act (ICRA) as well as Iowa’s administrative regulation excluding gender affirming medical care from Medicaid. On August 10, 2022, the district court granted in part and denied in part the state’s motion to dismiss. The court subsequently ruled that Iowa’s regulatory ban on Medicaid coverage for gender-affirming surgery and the amendment of ICRA to exclude gender-affirming surgery violate the equal protection clause of the Iowa Constitution.

Both sides appealed to the Iowa Supreme Court. The State did not appeal the district court’s decision regarding the exclusionary regulation, but did appeal the ICRA ruling. The Iowa Department of Human Services also agreed to cover the plaintiffs’ surgeries under Medicaid. The Iowa Supreme Court found the State’s ICRA appeal to be moot. It also affirmed the district court’s denial of plaintiffs’ request for attorney’s fees.

After so many years trying to access the healthcare that they need and fighting the State’s continuous efforts to deny them that healthcare, we are thrilled that the enforcement of the exclusionary regulation has ceased and that our clients Mika Covington and Aiden Vasquez are able to access care.

Vasquez and Covington are represented by Li Nowlin-Sohl from the National ACLU LGBTQ & HIV Project, Rita Bettis Austen and Shefali Aurora from the ACLU of Iowa, and Seth Horvath, Tina B. Solis, and F. Thomas Hecht, Litigation Partners at the Chicago office of Nixon Peabody LLP.