Judge Overturns Iowa’s Transgender Medicaid Ban

Iowa is no longer allowed to deny transgender people on Medicaid medically necessary care.

That is the latest ruling to come out of an Iowa District Court after two transgender ACLU clients, Carol Ann Beal and EerieAnna Good, won their cases for trans-affirming surgeries under Medicaid.

The ruling, issued Thursday by an Iowa District County Court, overturns an Iowa Department of Human Services (DHS) ban on coverage for transgender surgeries under Medicaid that has been in place since 1995, according to court documents.

The ban flies in the face of established medical recommendations in healthcare including the the American Psychological Association and the  American Medical Association. It also violates the Affordable Care Act’s 1557 Anti-Discrimination Protections, which mandate that Medicaid programs cover transition-related care.

But the 43-page ruling hinges on the state’s violation of Iowa’s constitution and the Civil Rights Act.

“DHS is excluding Iowa Medicaid coverage for surgical treatment of Gender Dysphoria purely on the basis that it is treatment of Gender Dysphoria of transgender individuals,” wrote Judge Arthur Gamble. “DHS does not explain why the medical necessity of requests for sex reassignment surgeries could not simply be evaluated under the same criteria as other requested surgeries or treatment of non-transgender individuals.”

Both clients in the case have identified as female since childhood, according to court records. Good is 27, and Beal is 42. Each has taken steps toward transitioning, and their physicians have recommended gender-affirming surgeries.  

Both have been denied coverage for about a year.

In a statement, Beal noted the ruling was a long time coming.

“I look forward to the day when someone fighting to get the transition-related medical care they need isn’t in the news because they had to go to court to fight for it,” Beal said. “But I’m doing it because someone needs to be the trailblazer here.”

DHS declined to comment on the outcome of the case as it relates to litigation.

Before the ruling, Iowa was among nine other states violating the Affordable Care Act by denying transition-related care to trans people. According to the Movement Advancement Project, 13 percent of LGBTQ people live in states with transgender Medicaid exclusions.

Last month, the National Health Law Program and two Wisconsin residents sued the state over its trans Medicaid ban. Cody Flack and Sara Makenzie claim that the state illegally denied them medical care.

Joseph Wardenski, the lead attorney on the case, says the Iowa ruling sends a clear message that transgender medical care is life-saving and that Medicaid programs which deny that care are discriminatory.

“We are pretty optimistic that the federal court in Flack and the Wisconsin case will find that Wisconsin’s policy is equally unlawful and harmful to trans people,” he said.