The Iowa Court of Appeals has upheld a ruling throwing out a lawsuit involving the payment for sex-change surgeries.

The lawsuit was brought by Mika Covington, Aiden Vasquez, and the group One Iowa, which sought to overturn a law passed in the last days of the 2019 legislative session that allows government entities to opt-out of using Medicaid, to pay for transition-related surgeries.

The legislature’s move followed a March 2018 Iowa Supreme Court ruling that the ban on using Medicaid funds for transition-related care was discriminatory under the Iowa Civil Rights Act.

The Appeals Court upheld the district court ruling,  saying the two had not exhausted their administrative appeals,  and until their Medicaid providers deny them coverage, the controversy is purely abstract because they have not been adversely affected in a concrete way.

Here’s the ruling: Medicaid Appeal Ruling PDF