An Iowa law preventing Medicaid from covering gender confirmation-related surgery violates the Iowa Civil Rights Act and the Iowa Constitution, a judge ruled Friday.

Polk County District Court Judge William P. Kelly ruled that the provision of the law that excludes coverage for surgery shall be stricken from the state's administrative code and that the remainder of the law must be interpreted and applied to allow transgender Iowans to receive coverage for medically necessary surgery to treat gender dysphoria and other diagnoses.

The American Civil Liberties Union of Iowa sued the state in April on behalf of two transgender Iowans, Aiden Vasquez and Mika Covington, who were denied coverage for gender-affirming surgeries.

The two Iowans qualify for Medicaid and their doctors agreed they needed gender-affirming surgery to treat their gender dysphoria. All major medical associations agree that transition-related care, including surgeries, are medically necessary when prescribed by a doctor.

Rita Bettis Austen, the ACLU of Iowa's legal director, said in a statement that she is relieved the court has ordered the state to allow her clients to receive the medically necessary surgeries.

"This is a historic win for civil rights in Iowa," she said. "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."

Republicans in the Iowa Legislature passed the law excluding gender confirmation surgeries from Medicaid coverage in 2019, after the Iowa Supreme Court ruled that an Iowa Department of Human Services regulation that banned using Medicaid funds to cover the surgeries was discriminatory based on the Iowa Civil Rights Act.

Sexual orientation and gender identity were added to the Iowa Civil Rights Act as protected classes in 2007, giving LGBTQ Iowans, including transgender Iowans, additional legal protections against discrimination in education, employment, housing and public accommodations.

Gender identity is a person's internal, deeply held sense of their gender, which, for transgender people, differs from the sex they were assigned at birth.

Gov. Kim Reynolds, a Republican, signed the law in 2019 and has previously defended the ban on using taxpayer funds to cover gender confirmation-related surgeries.

"The governor’s office is disappointed in today’s decision and disagrees with the district court’s ruling on Medicaid coverage for transgender reassignment surgeries," Reynolds' spokesperson, Alex Murphy, said in a statement. "We are reviewing the decision with our legal team and exploring all options moving forward."

This is the second lawsuit to challenge the law. The Iowa Court of Appeals ruled last summer in the previous case that the plaintiffs had not exhausted the internal Medicaid appeals process or been denied coverage. Since then, the Iowa Department of Human Services denied coverage for both plaintiffs. At that point, the ACLU filed the current lawsuit.

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