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.

For Aiden Vasquez and Mika Covington, the news was life-changing. Polk County District Court Judge William Kelly ruled on November 19 that Iowa’s law designed to deny Medicaid coverage for gender-affirming surgery “violates the equal protection clause of the Iowa Constitution.”

He ordered the Iowa Department of Human Services to change a longstanding regulation “excluding coverage for sex reassignment surgery” and said the agency must apply the revised rule to allow “transgender individuals coverage under Iowa Medicaid for medically necessary gender affirming surgery for the treatment of Gender Dysphoria and other relevant diagnoses.”

Vasquez and Covington are transgender Iowans who qualify for Medicaid and have been unable to obtain the health care they need for years. They have been seeking legal redress since soon after Governor Kim Reynolds signed the discriminatory statute in May 2019.

Naturally, not everyone was happy with what the ACLU of Iowa’s legal director Rita Bettis Austen described as a “historic win for civil rights in Iowa.” Soon after the court ruling was published on November 22, Reynolds’ spokesperson Alex Murphy told reporters, “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 echoed the sentiment when speaking to reporters on November 23: “Of course we were disappointed with the ruling and disagree […] My legal team is looking at it. There will be more to come later on. We’re still looking through it and trying to determine what our options are.”

She should stop fighting this battle.

Two years ago this week, on the day before the Iowa legislature completed its work for 2019, Republicans added two new discriminatory provisions to the state’s health and human services budget. Both code sections quickly spawned litigation. Planned Parenthood’s lawsuit against language designed to exclude the organization from sex education grants is now pending before the Iowa Supreme Court, after a District Court found the prohibition violated the state constitution’s equal protection guarantee.

A case challenging language that authorized discrimination against transgender Iowans on Medicaid never got that far. But on April 22, the ACLU of Iowa and the national ACLU LGBTQ & HIV Project filed a new lawsuit in Polk County District Court.