Gov. Kim Reynolds signed an Iowa budget bill Friday to pay for $1.9 billion in health programs, cut sex education funding for Planned Parenthood and allow governments not to use public dollars for gender reassignment surgeries.

The more than 100-page measure pays for addiction treatment, programs to help elderly Iowans, children with mental illnesses, people with brain injuries and veterans. The two most controversial provisions were last-minute additions to the health care budget bill.

One provision of the new law amends the state's Civil Rights Act to state that government officials are not required to pay for sex reassignment surgery. The change was mainly aimed at Medicaid, the federal and state health care program for poor or disabled Iowans.

"This narrow provision simply clarifies that Iowa’s Civil Rights Act does not require taxpayer dollars to pay for sex reassignment and other similar surgeries. This returns us to what had been the state’s position for years," Reynolds spokesman Pat Garrett said in a statement.

The American Civil Liberties Union of Iowa, in a statement, said that provision only affects "public accommodations" under the Iowa Civil Rights Act, including Medicaid.

"The law did not amend or alter any other section of the Iowa Civil Rights Act or impact other government funding of transgender care, such as that provided to state employees or prisoners," the American Civil Liberties Union of Iowa said in a statement.

The provision is a response to an Iowa Supreme Court ruling in March that was regarded as a landmark decision. The ruling struck down a ban on Medicaid payments for "surgeries for the purpose of sex reassignment."

One Iowa Action, an LGBTQ rights group, criticized the provision on gender reassignment surgeries, noting the Iowa Supreme Court's unanimous decision.

"By signing this cruel legislation into law, Gov. Reynolds has told every transgender Iowan that they are second-hand citizens and unwelcome in our state," the group said in a statement.

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The budget bill also cuts off about $260,000 in federal money from two grant programs that went to sex education programs offered by Planned Parenthood.

It's part of an ongoing effort by Republicans to restrict abortion and deny funding to Planned Parenthood, one of the nation's largest providers of reproductive health services, including abortion.

Federal law already prohibits using federal money to pay for abortions. No state money is used to pay for them.

Under the new law, an entity that performs or promotes abortions is prohibited from accessing federal money from the Personal Responsibility Education Program and the Community Adolescent Pregnancy Prevention and Services program.

Erin Davison-Rippey, state executive director of Planned Parenthood North Central States, issued a statement saying the cuts to sex education programs are contrary to Reynolds' efforts to reduce abortions.

"This is a huge loss to the thousands of youth who would benefit from comprehensive and nonjudgmental sex education," she said in the statement.