Judge Strikes Down Iowa Medicaid Ban on Transition-Related Health Care

By Shane Stahl • July 14, 2018 • 1:15 pm

On Thursday, June 12, Chief District Judge Arthur Gamble of the Iowa District Court struck down an exemption from the state’s Medicaid program that banned coverage of transition-related healthcare, paving the way for transgender people to receive necessary medical services to affirm their gender identity.

The state had sought an exemption from providing transition-related services, categorizing them as “cosmetic, reconstructive, or plastic surgery,” and explicitly banning, in their terms, “surgeries for the purpose of sex reassignment.”

The nation’s major medical groups, including the American Medical Association and the American Psychological Association, have stated that transition-related healthcare, including gender confirmation surgery, is essential for transgender people to live full and healthy lives, while also noting that surgery is not the decision of every transgender person.

Rita Bettis, Legal Director of the ACLU of Iowa, said after the ruling:

“Today is a historic day for civil rights in Iowa. We are extremely relieved for our clients who now, after a very long wait, can finally get the care they need (and) that all of their doctors agree is medically necessary for them.”

Two transgender women, Carol Ann Beal of northwest Iowa and EerieAnna Good of the Quad Cities, filed suit with the assistance of our legal partners at the ACLU challenging the state’s ban. Since 2007, gender identity and sexual orientation have been considered protected classes under Iowa’s Civil Rights Law; Medicaid, funded at the state and federal level, is considered a public accommodation.

In his ruling, Judge Gamble said that the regulation blocking transition-related care “has not kept up with law and medicine,” and that the state’s Department of Human Services, the administrator for Medicaid, had “an obligation to keep up with medical science. DHS failed to do so when it denied coverage to Good and Beal for medically necessary gender-affirming surgery. This decision was made without regard to the law and facts;” the decision is the first ruling recognizing that transgender Iowans are guaranteed Medicaid coverage.

Daniel Hoffman-Zinnel, executive director of One Iowa, the state’s leading LGBTQ advocacy group, said in a statement:

“Through our work with transgender Iowans, we have seen firsthand how powerful, life-changing, and absolutely essential gender-affirming surgery can be for transgender people grappling with gender dysphoria. This decision will, quite literally, save lives.”


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